PR-96 | Non-covered charge(s)

Industry

Insurance

Canonical

/insurance/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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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-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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