PR-150: Information Does Not Support Level of Service

What Does PR-150 Mean?

With PR (Patient Responsibility), the information does not support level of service 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 payer paid for a lower level of service and the difference between the billed level and the approved level is shifted to the patient as their financial responsibility.

CARC 150 indicates information does not support level of service. 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 clinical documentation does not demonstrate the medical necessity or complexity required to justify the level of service billed, such as billing a level 5 E/M when documentation supports only a level 3; The payer's review determined that the service was billed at a higher level than the documentation supports, resulting in a downgrade or denial; Required medical records, progress notes, or clinical documentation that would support the billed level of service were not submitted with the claim or upon request. The group code paired with CARC 150 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

How to Resolve

1. Review the adjustment Examine the PR-150 adjustment and any RARC codes to understand the basis for the patient responsibility.
2. Verify the adjustment is correct Confirm the PR designation and amount are appropriate based on the patient's plan benefits.
3. Appeal if incorrect Appeal on behalf of the patient if documentation supports the higher level of service. Include clinical records demonstrating the complexity and medical necessity of the billed service level.
4. Collect from the patient if valid If the adjustment is confirmed correct, generate a patient statement and follow standard collection procedures.

How to Prevent PR-150

• Verify patient benefits and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively

Also Filed As

The same CARC 150 may appear with different Group Codes:

Related Denial Codes