CARC 202 Active

PR-202: Non-Covered Personal Comfort or Convenience Services

TL;DR

The patient owes for the comfort or convenience item. 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-202 Mean?

With PR (Patient Responsibility), the patient is financially responsible for the personal comfort or convenience item. The service is not covered by insurance and the patient must pay out of pocket. Collect from the patient.

CARC 202 indicates that the payer considers the billed service to be for the patient's personal comfort or convenience rather than medically necessary treatment. Common examples include television rental during a hospital stay, private room upgrades when a semi-private room was medically sufficient, guest meals, cosmetic procedures, and other amenities that are not required for the patient's medical care.

This code can also appear when documentation does not adequately distinguish a medically necessary service from a comfort item. For instance, a private room may be medically required for infection control purposes, but without proper documentation, the payer may classify it as a personal convenience.

Common Causes

Cause Frequency
Patient requested personal comfort items The patient specifically requested non-covered comfort items or services during their stay and is responsible for the cost Most Common
Elective upgrade chosen by patient The patient elected a service upgrade (e.g., private room when semi-private was medically sufficient) and is responsible for the difference Common

How to Resolve

  1. Confirm the service is a comfort item Verify the service is genuinely a non-covered comfort or convenience item.
  2. Communicate with the patient Inform the patient of the charges for the non-covered comfort item.
  3. Collect from the patient Send a statement and collect the balance.
Do Not Appeal This Code

This service was classified as a personal comfort or convenience item that is not covered by the patient's insurance plan. The patient is responsible for the cost of these services. Collect the balance from the patient.

How to Prevent PR-202

Also Filed As

The same CARC 202 may appear with different Group Codes:

CO-202 OA-202

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://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/202
  3. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  4. Codes maintained by X12. Visit x12.org for official definitions.