PR-204 | Service not covered under patient plan

Industry

Healthcare

Canonical

/insurance/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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Use these links to pivot between the directory, a focused guide, and nearby related codes.

Hub

Guides

The Complete Insurance Claim Denial Codes Directory (2026 Edition)

Related Codes

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

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