PR-241: Low Income Subsidy (LIS) Co-payment Amount
The patient owes the LIS co-payment amount. Collect only this reduced amount from the patient.
What Does PR-241 Mean?
With PR (Patient Responsibility), the LIS co-payment is the patient's financial obligation. This is the standard group code for CARC 241. The amount is typically very small ($0 to a few dollars) per prescription.
CARC 241 indicates the co-payment amount assigned to a Medicare Part D beneficiary who qualifies for the Low Income Subsidy (LIS), also known as Extra Help. LIS beneficiaries receive reduced cost-sharing on their prescription drugs — their co-payments are significantly lower than standard Part D co-payments, typically ranging from $0 to a few dollars per prescription.
This code is not a denial — it is an informational adjustment showing the small co-payment amount the patient owes. The LIS program is designed to help low-income Medicare beneficiaries afford their medications, and the co-payment amounts are set by CMS annually.
Common Causes
| Cause | Frequency |
|---|---|
| Medicare Part D LIS copayment applied The patient qualifies for the Medicare Part D Low Income Subsidy and their reduced copayment amount has been applied to the claim | Most Common |
| Dual-eligible beneficiary copayment The patient is eligible for both Medicare and Medicaid, and their reduced copayment amount under LIS is applied | Common |
| Reduced cost-sharing per LIS qualification level The copayment amount reflects the patient's specific LIS qualification level (full subsidy or partial subsidy) | Common |
How to Resolve
- Verify the co-payment Confirm the LIS co-payment matches the patient's subsidy level.
- Collect from the patient Collect only the designated LIS amount — do not charge more.
- Apply the payment Record the LIS co-payment correctly.
This is the standard Low Income Subsidy copayment amount per the patient's LIS qualification level. Collect only the reduced copayment amount from the patient. Charging more than the LIS copayment amount may violate federal regulations.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-241:
| RARC | Description |
|---|---|
| N781 | Alert: Patient is a Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. Verify the patient's LIS level and do not collect more than the applicable reduced copayment → |
How to Prevent PR-241
- Verify LIS status and co-payment amounts at the point of sale
- Stay current on annual CMS updates to LIS co-payment amounts
- Train pharmacy staff on LIS co-payment collection rules
General Prevention
- Verify patient LIS status before collecting copayments
- Configure your pharmacy or billing system to apply correct LIS copayment amounts automatically
- Train staff on LIS copayment levels and the prohibition on collecting excess amounts from LIS beneficiaries
- Monitor CMS updates to LIS copayment amounts annually (amounts change each year)
Also Filed As
The same CARC 241 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.