CARC 108 Active

PR-108: Rent/Purchase Guidelines Not Met

TL;DR

The patient owes this rent/purchase guidelines not met amount. Verify the balance and collect from the patient.

Action
Collect from Patient
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does PR-108 Mean?

With PR (Patient Responsibility), the rent/purchase guidelines not met is the patient's financial obligation. The insurer processed the claim, applied the patient's plan benefits, and this amount is owed directly by the patient. The most common scenario is the rental period has ended and the patient now owns the equipment or must purchase it, making additional costs the patient's responsibility.

CARC 108 indicates rent/purchase guidelines not met. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the durable medical equipment has been rented beyond the maximum rental period allowed by the payer, and the claim for additional rental months is denied; The patient did not elect to purchase the rented equipment within the payer-required timeframe, and billing for additional rental periods is not allowed; The claim was submitted with the wrong modifier indicating rental when purchase was required, or vice versa, based on the payer's rent/purchase guidelines. The group code paired with CARC 108 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

Common Causes

Cause Frequency
Patient responsible for equipment after rental cap The rental period has ended and the patient now owns the equipment or must purchase it, making additional costs the patient's responsibility Most Common
Patient elected purchase option with cost-sharing The patient elected to purchase the equipment, and the purchase cost-sharing amount is the patient's responsibility Common

How to Resolve

  1. Verify the rent/purchase guidelines not met amount Cross-reference the adjusted amount against the patient's benefits summary or eligibility response to confirm the rent/purchase guidelines not met amount was applied correctly per plan terms.
  2. Confirm plan benefit details Review the patient's specific plan structure. Confirm the correct amount was applied for this service type.
  3. Generate a patient statement Prepare a clear statement showing the service rendered, the allowed amount, the rent/purchase guidelines not met amount, and the balance the patient owes.
  4. Collect from the patient Send the statement and follow your practice's collection workflow. Offer payment plan options for substantial balances.
  5. Track and follow up Record payments received, update the account balance, and follow up on outstanding amounts per your collection policy.
Do Not Appeal This Code

The patient is responsible for equipment costs after the rental period guidelines are met. Collect from the patient.

How to Prevent PR-108

Also Filed As

The same CARC 108 may appear with different Group Codes:

CO-108 OA-108

Related Denial Codes

PR-1 — Deductible Amount PR-2 — Coinsurance Amount PR-3 — Co-payment Amount PR-23 — Prior Payer Adjudication Impact PR-66 — Blood Deductible

Sources

  1. https://www.cms.gov/medicare/coverage/dmepos
  2. https://www.aapc.com/resources/claim-adjustment-reason-code-carc
  3. https://www.mdclarity.com/denial-code/108
  4. Codes maintained by X12. Visit x12.org for official definitions.