PR-B14: Only One Visit/Consultation Per Physician Per Day Covered
PR-B14 means the patient owes for the additional same-day visit. Verify the visits were not distinct before collecting.
What Does PR-B14 Mean?
When paired with Group Code PR, the patient is responsible for the non-covered second visit. This applies when the plan covers one visit per day and additional visits are the patient's responsibility. Collect from the patient after verifying the denial is correct.
CARC B14 indicates the payer denied a claim because only one visit or consultation per physician per day is covered under the plan. The provider billed for two or more evaluation and management services for the same physician and patient on the same date, and the payer only pays for one.
This rule prevents unbundling of a single encounter into multiple visits. However, there are legitimate situations where two separate encounters on the same day are appropriate — for example, when a patient returns for a new problem, or when a separately identifiable E/M service is performed alongside a procedure. In these cases, modifier 25 (Significant, Separately Identifiable Evaluation and Management Service) should be appended to the second E/M service.
If the second visit was a follow-up for the same condition seen earlier in the day, the services should be consolidated into a single encounter rather than billed as two separate visits.
Common Causes
| Cause | Frequency |
|---|---|
| Patient scheduled multiple same-day visits The patient saw the same physician twice in one day and the second visit is the patient's responsibility | Common |
| Non-covered additional visit The plan covers one visit per day and additional visits are patient responsibility | Common |
How to Resolve
- Verify the visits were not distinct If the visits were distinct, appeal with modifier 25 to remove patient liability.
- Collect if valid If the second visit was truly a separate same-day visit, collect from the patient.
Appeal with documentation showing the visits were for distinct medical needs and should be separately covered.
How to Prevent PR-B14
- Inform patients during scheduling that only one visit per day per physician is covered
- Consolidate care needs into a single visit when possible
Also Filed As
The same CARC B14 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.cms.gov/regulations-and-guidance/guidance/manuals
- Codes maintained by X12. Visit x12.org for official definitions.