CARC 262 Active

PR-262: Adjustment for Delivery Cost (Pharmaceuticals Only)

TL;DR

The payer adjusted the delivery cost for a pharmaceutical claim. Verify the charge is within the payer's allowed limits and that your documentation is complete. Resubmit with corrections or appeal if the charge should be covered.

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-262 Mean?

CARC 262 is a pharmaceutical-specific adjustment code that addresses the delivery cost component of a drug claim. When a pharmacy or provider bills for medication delivery, the payer may adjust this charge based on its fee schedule, contract terms, or coverage limitations for delivery services.

This code applies exclusively to pharmaceutical claims — it is not used for other types of delivery services. The adjustment may indicate that delivery costs are not covered at all under the plan, that the billed amount exceeds the payer's allowed maximum, that billing errors caused the charge to be denied, or that supporting documentation (delivery invoices, proof of delivery) was not provided.

Pharmaceutical delivery cost coverage varies significantly between payers. Some plans include delivery costs in the drug reimbursement, others pay a separate delivery fee up to a maximum amount, and some plans exclude delivery costs entirely. Understanding your payer's specific policy is essential for correct billing.

How to Resolve

Verify the delivery cost is within the payer's allowed amount, confirm coding accuracy, and resubmit with corrections or supporting documentation.

  1. Review the claim details Confirm the delivery cost is appropriately billed for pharmaceutical items and correctly coded.
  2. Validate coding accuracy Verify the pharmaceutical codes and delivery charge codes are correct against the payer's requirements.
  3. Check the payer's allowed amount Compare your delivery charges against the payer's maximum allowable amount for pharmaceutical delivery.
  4. Gather supporting documentation Compile delivery invoices, proof of delivery, and any other supporting records.
  5. Resubmit or appeal If billing errors were found, correct and resubmit. If the charges are legitimate and covered, appeal with supporting documentation.
  6. Monitor claim status Track the resubmitted or appealed claim and follow up if not processed within expected timeframes.
Do Not Appeal This Code

Adjustment for Delivery Cost (Pharmaceuticals Only) 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.

Also Filed As

The same CARC 262 may appear with different Group Codes:

CO-262 OA-262

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://www.mdclarity.com/denial-code/262
  2. https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.