CARC 205 Active

PR-205: Pharmacy Discount Card Processing Fee

TL;DR

Patient responsibility for a processing fee is unusual. Verify the group code assignment.

Action
Review & Decide
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-205 Mean?

With PR (Patient Responsibility), the patient may be charged a portion of the discount card processing cost. This is unusual and may indicate a billing error. Verify the assignment.

CARC 205 represents a per-transaction processing fee that is deducted from the pharmacy's payment when a claim is processed through a pharmacy discount card program. This is not a denial — it is a contractual fee reduction that the pharmacy agreed to when enrolling in the discount card program.

Pharmacy discount cards (such as GoodRx, SingleCare, or payer-specific discount programs) provide patients with reduced drug prices, but pharmacies pay a processing fee for each transaction. This fee is deducted from the pharmacy's reimbursement on each claim. The amount is determined by the pharmacy's contract with the discount card processor.

How to Resolve

  1. Verify the group code Contact the processor to confirm the PR assignment is correct.
  2. Correct if needed If incorrect, request the adjustment be reassigned to CO.
Do Not Appeal This Code

This is a contractual processing fee for the pharmacy discount card program. The fee is per the terms of your participation agreement. If you believe the fee amount is incorrect, contact the discount card processor directly rather than filing a payer appeal.

How to Prevent PR-205

Also Filed As

The same CARC 205 may appear with different Group Codes:

CO-205 OA-205

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/205
  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.