CARC 212 Active

PR-212: Administrative Surcharges Not Covered

TL;DR

The patient owes for the administrative surcharge. Collect from the patient.

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-212 Mean?

With PR (Patient Responsibility), the patient is responsible for the administrative surcharge. The insurance plan does not cover these fees.

CARC 212 indicates that the claim includes charges classified as administrative surcharges rather than medical services. These can include late payment penalties, administrative processing fees, convenience charges, or other non-clinical fees that payers do not recognize as covered services. Insurance plans typically cover only medically necessary services and do not reimburse for administrative add-on charges.

How to Resolve

  1. Communicate with the patient Inform the patient of the non-covered surcharge.
  2. Collect from the patient Bill the patient directly for the administrative charge.
Do Not Appeal This Code

Administrative surcharges are not covered under most payer contracts. Review your contract to confirm, and remove non-covered surcharges from future claims. If the surcharge is contractually billable, contact the payer with your contract documentation.

How to Prevent PR-212

Also Filed As

The same CARC 212 may appear with different Group Codes:

CO-212 OA-212

Related Denial Codes

PR-26 — Expenses Incurred Prior to Coverage PR-27 — Expenses Incurred After Coverage Terminated PR-32 — Patient Not Eligible Dependent PR-33 — Insured Has No Dependent Coverage PR-34 — No Coverage for Newborns

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. 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
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.