PR-66: Blood Deductible

What Does PR-66 Mean?

PR-66 assigns the blood deductible directly to the patient. The payer processed the claim correctly and determined the patient has unreplaced blood pints that must be paid out of pocket. Under Medicare, this covers up to three pints per calendar year. The provider is expected to collect this amount from the patient.

When CARC 66 appears on a remittance, the payer is telling you that blood or blood product charges were not reimbursed because the patient's blood deductible has not been satisfied. This is distinct from a standard annual deductible (CARC 1) — the blood deductible specifically applies to whole blood and packed red blood cell transfusion services.

Under Medicare Part A, patients are responsible for the first three pints of blood per calendar year unless those pints are replaced through a blood donation program. Commercial payers may have their own blood deductible structures. CARC 66 is overwhelmingly paired with Group Code PR, making the unreplaced blood charges the patient's direct financial responsibility. When you see CO-66, it typically signals a contractual arrangement where the provider absorbs the blood deductible cost — this is uncommon and worth verifying.

The practical impact depends on your facility's blood banking operations. If your hospital runs a blood replacement program, patients or their designees can donate blood to offset the deductible. Tracking replacement pints and coordinating with the blood bank before billing can prevent unnecessary patient balances and reduce collection friction. For Medicare patients, the blood deductible resets each calendar year, so watch for a fresh round of CARC 66 adjustments in January.

Common Causes

How to Resolve

Confirm the blood deductible status is accurate, check for replacement pints, then bill the patient or write off the amount depending on the group code.

1. Confirm unreplaced pint count Verify with the payer how many of the three Medicare blood deductible pints remain unreplaced and confirm the dollar amount per pint.
2. Check for blood replacement donations Review blood bank records to confirm whether the patient or a family member donated replacement pints. If replacements were made but not reflected, prepare documentation for the payer.
3. Transfer to patient ledger and bill Move the blood deductible amount to the patient's responsibility account. Generate a statement itemizing the blood deductible charge and include an explanation of the blood replacement program for future reference.
4. Follow patient collections workflow Enter the balance into your standard patient billing cycle. Track it separately from insurance denials since this is a legitimate patient obligation, not a payer dispute.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-66:

How to Prevent PR-66

• Verify the patient's blood deductible status before scheduling transfusion services using real-time eligibility verification
• Educate patients about the blood replacement program during pre-admission — a single donated pint can offset one pint of the deductible
• Coordinate with the blood bank to ensure replacement donations are properly documented and reported to the payer
• Collect the estimated blood deductible at the time of service, especially for elective transfusion procedures
• Track the three-pint accumulation across the calendar year for Medicare patients to know when the blood deductible has been satisfied

General Prevention

• Verify the patient's blood deductible status before scheduling blood-related procedures using real-time eligibility verification
• Educate patients about the blood deductible requirement and blood replacement programs before transfusion services
• Coordinate with the blood bank to track replacement pints and ensure proper documentation is submitted to the payer
• Collect estimated blood deductible amounts at the point of service when possible
• Track blood deductible accumulation across the calendar year for Medicare patients to identify when the three-pint threshold has been met

Also Filed As

The same CARC 66 may appear with different Group Codes:

Related Denial Codes