Healthcare Error Code
Healthcare Insurance / Medical Billing
Patient Responsibility (PR)
PR-204 | Service not covered under patient plan
Industry
Healthcare
Canonical
/healthcare/error-codes/pr-204/
Last Updated
Feb 25, 2026
Summary
This code indicates that the service is not covered and is the patient’s responsibility.
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What This Code Means
PR-204 assigns financial responsibility to the patient for a service excluded from coverage. This reflects plan design rather than claim submission issues. The service may be valid but not reimbursable. This code clarifies responsibility rather than denying the claim entirely.
Where Users Usually See This Code
- Explanation of Benefits
- Patient billing statements
- Remittance advice
Why This Code Appears
- The service is excluded from plan coverage
- Coverage limitations apply
- Benefit design restrictions enforced
What Typically Happens Next
- The patient balance reflects the charge
- The claim is closed
- No payer reimbursement occurs
What This Code Is Not
- It is not a billing error
- It is not a deductible or coinsurance
- It is not a processing delay
Troubleshooting Checklist
- □ Review plan exclusions
- □ Confirm benefit limitations
- □ Check for secondary coverage
Notes And Edge Cases
Some plans allow limited exceptions. Secondary insurance may alter final responsibility.
Related Codes
8 links
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