PR-66: Blood Deductible
The patient owes this blood deductible. Verify the balance and collect from the patient.
What Does PR-66 Mean?
With PR (Patient Responsibility), the blood deductible is the patient's financial obligation. The insurer processed the claim, applied the patient's plan benefits, and this amount is owed directly by the patient. The most common scenario is medicare requires the patient to pay for the first 3 pints of blood per calendar year (blood deductible).
CARC 66 appears on a remittance when the payer adjusts payment for the blood deductible. This is a standard plan-defined cost-sharing amount that the patient is obligated to pay per their insurance benefits. The code confirms the payer processed the claim correctly and applied the plan's benefit structure as designed.
Common scenarios that trigger this adjustment include: medicare requires the patient to pay for the first 3 pints of blood per calendar year (blood deductible); Patient or blood bank did not replace the blood units, triggering the deductible; Patient has not met the annual 3-pint blood deductible. The group code paired with CARC 66 determines who bears the financial responsibility — PR shifts it to the patient, CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment.
Common Causes
| Cause | Frequency |
|---|---|
| Medicare blood deductible applied Medicare requires the patient to pay for the first 3 pints of blood per calendar year (blood deductible) | Most Common |
| Blood not replaced Patient or blood bank did not replace the blood units, triggering the deductible | Common |
| Annual blood deductible not met Patient has not met the annual 3-pint blood deductible | Common |
How to Resolve
- Verify the blood deductible Cross-reference the adjusted amount against the patient's benefits summary or eligibility response to confirm the blood deductible was applied correctly per plan terms.
- Confirm plan benefit details Review the patient's specific plan structure. Confirm the correct amount was applied for this service type.
- Generate a patient statement Prepare a clear statement showing the service rendered, the allowed amount, the blood deductible, and the balance the patient owes.
- Collect from the patient Send the statement and follow your practice's collection workflow. Offer payment plan options for substantial balances.
- Track and follow up Record payments received, update the account balance, and follow up on outstanding amounts per your collection policy.
The blood deductible is a standard patient financial obligation under Medicare (first 3 pints per calendar year). This is not a payer error or coverage decision - it is a plan-defined patient responsibility. If blood was replaced by the patient or blood bank, provide replacement documentation instead of appealing.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-66:
| RARC | Description |
|---|---|
| N381 | Consult contract/fee schedule for payment information Review blood deductible terms and patient's remaining deductible → |
| N19 | Deductible amount Confirm the blood deductible calculation is correct → |
How to Prevent PR-66
- Inform patients about the blood deductible before transfusion when possible
- Encourage blood replacement programs to waive the deductible
- Track blood deductible status for Medicare patients
- Coordinate with blood bank on replacement programs
Also Filed As
The same CARC 66 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://revenuecyclemgmt.com/claim-adjustment-reason-codes/
- https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c22pdf.pdf
- Codes maintained by X12. Visit x12.org for official definitions.