PR-96: Non-covered charges (patient responsibility)
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
Like CO-96, but the payer is assigning the bill to you. Worth scrutiny — 'non-covered' labels are frequently wrong or appealable.
PR-96 at a glance
- Code group: PR — Patient Responsibility — the payer assigns this amount to you (verify before paying).
- Who usually fixes it: You (the member).
- Worth appealing? Yes — commonly appealed.
What to do about a PR-96 denial
- Demand the exact plan provision excluding the service.
- Compare against your Evidence of Coverage; exclusions are construed from the plan document, not the payer's summary.
- Appeal with plan language and clinical documentation when the exclusion doesn't fit.
Best next read: How to appeal, step by step — the full guide (with a free letter template) for this denial type.
Denied? Don’t drop it
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