PR-229: Partial Charge Not Considered Due to Type of Bill 12X
The patient owes for partial charges not processable on the interim bill. Collect from the patient.
What Does PR-229 Mean?
With PR (Patient Responsibility), the patient is responsible for the partial charges that could not be processed on the interim bill.
CARC 229 is specific to institutional claims and indicates that the payer cannot process partial charges on a claim submitted with type of bill 12X (interim billing for an ongoing inpatient stay). Interim bills represent charges for a continuing admission, and the payer's system does not calculate partial amounts on these bill types — it processes them as full interim periods.
This typically occurs when the provider submits an interim claim that includes a partial day or period that the payer's processing logic does not accommodate for this bill type.
Common Causes
| Cause | Frequency |
|---|---|
| Initial inpatient claim submitted with Type of Bill 12X The original hospital inpatient claim was submitted with a Type of Bill 12X (interim claim), and Medicare did not consider the partial charges on the subsequent claim | Most Common |
| Interim billing for long-term inpatient stay During a long inpatient stay, interim bills (12X) were submitted and the partial charge on the final claim is not considered separately by Medicare | Common |
| Medicare billing cycle adjustment The partial charges from the interim billing cycle are not applied to the patient's cost-sharing on the final claim | Common |
How to Resolve
- Verify the charges Confirm the partial charges that were not processed.
- Collect from the patient Bill the patient for the applicable amount.
This adjustment is a Medicare billing rule that partial charges are not considered when the initial claim was submitted with Type of Bill 12X (interim). The patient is responsible for this amount. If the Type of Bill was submitted in error, correct and resubmit the original claim.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-229:
| RARC | Description |
|---|---|
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Review the Type of Bill and correct if submitted incorrectly → |
How to Prevent PR-229
- Align billing periods with complete interim periods to avoid partial charge issues
- Submit final claims with the correct type of bill code
General Prevention
- Ensure the correct Type of Bill is used for all institutional claims (avoid using 12X when a final bill should be submitted)
- Train billing staff on proper interim billing procedures for long inpatient stays
- Review Medicare billing guidelines for Type of Bill requirements before submission
- Implement billing system edits that validate Type of Bill selection before claim submission
Also Filed As
The same CARC 229 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- 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
- https://www.aapc.com/resources/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.