CARC 232 Active

PR-232: Institutional Transfer Amount

TL;DR

Patient responsibility from a transfer adjustment is unusual. Verify the 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-232 Mean?

With PR, the patient is responsible for a portion related to the transfer adjustment. This is unusual for institutional transfer pricing.

CARC 232 is specific to inpatient institutional claims where the patient was transferred from one facility to another during the inpatient stay. Under Medicare's transfer policy, when a patient is transferred before the full episode of care is complete, the transferring hospital receives a per diem payment rather than the full DRG amount. The per diem rate is calculated based on the DRG payment divided by the geometric mean length of stay.

This adjustment ensures the transferring hospital is paid proportionally for the portion of the inpatient stay they provided, rather than receiving the full DRG payment for an incomplete stay.

How to Resolve

  1. Verify the PR assignment Contact the payer to confirm patient responsibility.
  2. Collect if confirmed If PR is correct, communicate and collect from the patient.
Do Not Appeal This Code

Institutional Transfer Amount grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-232

Also Filed As

The same CARC 232 may appear with different Group Codes:

CO-232 OA-232

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://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.