PR-229: Medicare Partial Charge on 12X Bill Type

What Does PR-229 Mean?

PR-229 is the only valid group code for this adjustment. It indicates that the partial charge amount Medicare excluded due to the 12X bill type is the patient's direct financial responsibility. This is not a provider write-off — the charges are assigned to the patient because Medicare's COB rules do not cover this portion under the bill type used.

CARC 229 is a Medicare-specific Coordination of Benefits adjustment that applies to institutional claims submitted with Type of Bill 12X (inpatient hospital, interim first claim). When Medicare encounters this bill type, it does not consider partial charge amounts, and the resulting difference is assigned to the patient's responsibility under Group Code PR.

This code is used in the 837 transaction to convey COB information when a secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. It tells the provider that Medicare has applied a specific calculation rule based on the bill type designation, and the partial charge that Medicare excluded is now the patient's obligation.

Unlike most denial codes, CARC 229 is highly specialized and institutional in nature. It only triggers on 12X bill types and is always paired with PR. The key question when you see this code is whether the 12X bill type was the correct designation for the services provided — if not, correcting the bill type may resolve the issue entirely.

Common Causes

How to Resolve

Verify the Type of Bill designation was correct for the services rendered, ensure COB information is properly conveyed, and resubmit or bill the patient accordingly.

1. Confirm the adjustment is correct Review the claim to verify that the Type of Bill 12X was appropriate and that the partial charge exclusion was correctly calculated by Medicare.
2. Check for secondary coverage Determine whether the patient has secondary insurance that might cover the excluded partial charge amount, and submit to the secondary payer if applicable.
3. Bill the patient or correct the claim If the adjustment is valid and no secondary coverage exists, bill the patient for the PR amount. If the bill type was incorrect, correct and resubmit to Medicare.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-229:

How to Prevent PR-229

• Verify the correct Type of Bill code before submitting institutional claims to Medicare
• Understand when 12X versus other inpatient bill types should be used
• Implement billing software edits that flag 12X claims for review before submission
• Ensure 837 transactions include complete COB information when applicable

General Prevention

• Verify the correct Type of Bill code before submitting institutional claims to Medicare, paying special attention to 12X versus other inpatient bill types
• Understand and follow the secondary payer's cost avoidance policy when bypassing primary payer claim submission
• Ensure 837 transactions properly convey all COB information when applicable
• Verify patient Medicare eligibility and coverage details before claim submission
• Implement billing software checks that flag Type of Bill 12X claims for review before submission

Related Denial Codes