Healthcare Error Code
Healthcare Insurance / Medical Billing
Patient Responsibility (PR)
PR-96 | Non-covered charge(s)
Industry
Healthcare
Canonical
/healthcare/error-codes/pr-96/
Last Updated
Feb 25, 2026
Summary
This code indicates that specific charges are not covered and are assigned to patient responsibility.
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What This Code Means
PR-96 is used when non-covered charges are assigned directly to the patient. The service may be valid but excluded under plan terms. This code clarifies financial responsibility rather than indicating a billing error. Coverage exclusions drive its application.
Where Users Usually See This Code
- Explanation of Benefits
- Patient billing summaries
- Remittance advice
Why This Code Appears
- Charges are excluded under plan benefits
- Coverage limits apply
- Policy exclusions enforced
What Typically Happens Next
- Patient balance includes the non-covered charges
- The claim line is finalized
- No further payer action occurs
What This Code Is Not
- It is not a deductible or coinsurance
- It is not a contractual adjustment
- It is not a temporary hold
Troubleshooting Checklist
- □ Review benefit exclusions
- □ Confirm coverage details
- □ Monitor billing statements
Notes And Edge Cases
Coverage exclusions vary by policy. Some charges may be covered under alternate plans.
Related Codes
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