PR-202: Non-Covered Personal Comfort or Convenience Services

What Does PR-202 Mean?

PR-202 means the patient is responsible for the charges because the service was classified as a personal comfort or convenience item and the patient was informed (typically through an ABN) that it would not be covered. The patient elected to receive the service knowing they would pay out of pocket. The provider should bill the patient for the full amount.

CARC 202 denies payment because the payer has determined that the billed service falls into the category of personal comfort or convenience rather than medical necessity. This classification covers items and services that make the patient more comfortable but are not required for their clinical care — private rooms when a semi-private room is available and clinically adequate, television or phone rentals, guest meals, cosmetic enhancements, and similar amenities.

The critical distinction with CARC 202 is between genuine comfort items and services that appear to be comfort items but have a legitimate clinical justification. A private room requested for patient preference is a comfort item. A private room required for airborne infection isolation is medically necessary. The difference lies entirely in the clinical documentation — if the physician documented the medical reason for the service, the denial can often be overturned on appeal.

For Medicare claims, the Advance Beneficiary Notice (ABN) is central to how this denial is resolved. If an ABN was issued before the service and the patient signed it acknowledging potential non-coverage, the provider can bill the patient under PR. If no ABN was obtained, the provider typically must absorb the cost under CO. This makes proactive identification of potentially non-covered comfort services and timely ABN issuance essential to financial protection.

Common Causes

How to Resolve

Determine whether the service was medically necessary or truly a comfort item, then appeal with documentation or bill the patient based on ABN status.

1. Confirm ABN or patient notification is on file Verify that the patient signed an ABN or financial responsibility acknowledgment before the service was provided. This document is your authority to bill the patient.
2. Generate a patient statement Bill the patient for the comfort or convenience service with a clear explanation that the service was not covered by their insurance as it was classified as a personal comfort item.
3. Address patient disputes If the patient disputes the charge, refer to the signed ABN or financial responsibility form. If the patient was not properly notified, you may need to negotiate or absorb part of the cost.

How to Prevent PR-202

• Obtain an ABN or financial responsibility acknowledgment from every patient before providing any service that may be classified as personal comfort or convenience
• Clearly explain to patients which services are considered comfort items and what they will cost before delivery
• Provide upfront cost estimates for non-covered comfort services so patients can make informed decisions

General Prevention

• Clearly inform patients which services are classified as comfort or convenience and will be their financial responsibility before delivery
• Have patients sign an ABN or financial responsibility acknowledgment for any comfort or convenience services they request

Also Filed As

The same CARC 202 may appear with different Group Codes:

Related Denial Codes