CARC 122 Active

PR-122: Psychiatric Services Reduction

TL;DR

The patient owes this psychiatric services reduction. 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-122 Mean?

With PR (Patient Responsibility), the psychiatric services reduction 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 patient's plan requires higher copay or coinsurance for outpatient mental health services compared to medical/surgical services.

CARC 122 means the payer adjusted the payment based on psychiatric services reduction. The reimbursement was calculated using the payer's fee schedule, contracted rate, or regulatory payment methodology rather than the billed charge.

Common scenarios that trigger this adjustment include: the plan applies a reduction or limitation on outpatient mental health services that differs from medical/surgical benefits, resulting in lower reimbursement; Historically, Medicare applied a reduction to outpatient psychiatric services (the outpatient mental health treatment limitation). While largely eliminated by the MHPAEA, some legacy adjustments may still appear; The payer applies different cost-sharing or coverage limits for mental health services compared to medical/surgical services, which may violate mental health parity requirements. The group code paired with CARC 122 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
Higher patient cost-sharing for mental health services The patient's plan requires higher copay or coinsurance for outpatient mental health services compared to medical/surgical services Most Common
Mental health session limit reached The patient has exhausted their covered mental health visits and is responsible for additional session charges Common

How to Resolve

  1. Verify the psychiatric services reduction Cross-reference the adjusted amount against the patient's benefits summary or eligibility response to confirm the psychiatric services reduction 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 psychiatric services reduction, 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

This is the patient's cost-sharing obligation per the mental health benefit terms. Collect from the patient.

How to Prevent PR-122

Also Filed As

The same CARC 122 may appear with different Group Codes:

CO-122 OA-122

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/mental-health
  2. https://www.aapc.com/resources/claim-adjustment-reason-code-carc
  3. https://www.mdclarity.com/denial-code/122
  4. Codes maintained by X12. Visit x12.org for official definitions.