PR-189: No Specific Procedure Code for Service Billed

What Does PR-189 Mean?

With PR (Patient Responsibility), the patient is financially responsible because the unlisted code could not be processed. This is unusual and may be resolved by providing proper documentation or identifying a specific code.

CARC 189 appears when the claim was submitted with an unlisted procedure code (often ending in 99 for CPT codes) and the payer either believes a more specific code should have been used, or the required supporting documentation for the unlisted code was not included. When providers use unlisted codes, payers typically require a detailed description of the service, an operative report, and comparable procedure pricing to process the claim.

Unlisted codes are legitimate when no specific CPT or HCPCS code exists for the service performed, but they require significantly more documentation than standard codes. The payer cannot determine appropriate reimbursement without understanding exactly what was done and how it compares to other coded procedures.

How to Resolve

1. Try to resolve the coding issue Find a specific code or submit required documentation to get the claim reprocessed.
2. Collect from the patient if unresolvable If the claim cannot be processed, communicate the charges to the patient.

How to Prevent PR-189

• Ensure proper coding and documentation before submitting claims to prevent patient charges

Also Filed As

The same CARC 189 may appear with different Group Codes:

Related Denial Codes