PR-49: Routine/preventive exam not covered
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
The payer classified the service as a routine exam outside benefits. But most plans must cover a defined set of preventive services at no cost — miscoding causes many of these denials.
PR-49 at a glance
- Code group: PR — Patient Responsibility — the payer assigns this amount to you (verify before paying).
- Who usually fixes it: You and the billing office together.
- Worth appealing? Sometimes — depends on the facts.
What to do about a PR-49 denial
- Check whether the service is on your plan's preventive list (most in-network preventive care is $0 under federal rules).
- If it was preventive, ask the provider to re-code and resubmit.
- Appeal if the payer still refuses a service your plan's preventive benefits cover.
Best next read: How to appeal, step by step — the full guide (with a free letter template) for this denial type.
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