CARC 264 Active

PR-264: Adjustment for Postage Cost (Pharmaceuticals Only)

TL;DR

The payer adjusted the postage cost on a pharmaceutical claim. Verify the charge is covered under the plan and supported by receipts, then resubmit with corrections or appeal if warranted.

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-264 Mean?

CARC 264 is a pharmaceutical-specific adjustment code addressing postage costs associated with mailing medications to patients. This code applies when a pharmacy or provider bills for the postage of pharmaceutical products and the payer adjusts the charge.

Postage costs are distinct from shipping costs (CARC 263) — postage specifically refers to USPS or postal service charges for mailing medications. The adjustment may indicate the plan does not cover postage costs, the billed amount exceeds plan limits, billing codes were incorrect, or required prior authorization for mail-order pharmaceuticals was not obtained.

Mail-order pharmacy programs have specific postage reimbursement policies that differ from standard shipping. Some programs absorb postage costs in the dispensing fee, others have flat-rate postage allowances, and some require the pharmacy to absorb postage as a cost of doing business.

How to Resolve

Verify the postage charge is reimbursable, confirm coding, and resubmit with corrections or supporting documentation.

  1. Confirm postage reimbursement eligibility Check the payer's policy on pharmaceutical postage cost reimbursement.
  2. Verify coding accuracy Confirm medication service and postage charge codes are correct.
  3. Provide supporting documentation Include postage receipts, prescriptions, and medication order documentation.
  4. Resubmit with corrections Correct any billing errors and resubmit the claim with proper postage documentation.
  5. Monitor reimbursement Track the resubmitted claim for proper processing.
Do Not Appeal This Code

Adjustment for Postage 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 264 may appear with different Group Codes:

CO-264 OA-264

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/264
  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.