PR-247: Professional Service Deductible on Institutional Claim

What Does PR-247 Mean?

PR-247 confirms the deductible amount for the professional service component is the patient's financial responsibility. The patient owes this amount regardless of which claim form the service was billed on. The payer has processed the claim and determined the patient's deductible obligation for the professional service rendered in the institutional setting. This is standard patient cost-sharing, not a denial.

CARC 247 appears when a payer processes an institutional claim (UB-04) that includes a professional service component and identifies the patient's deductible obligation for that professional component. This code separates the professional service deductible from the overall institutional claim so the provider can properly allocate patient cost-sharing between facility and professional service components.

This is not a denial — it is a standard patient responsibility determination. The payer has processed the claim and determined that the patient owes a deductible amount for the professional service portion of the care received in the institutional setting. The code appears almost exclusively with Group Code PR (Patient Responsibility), confirming the amount should be collected from the patient.

Providers commonly encounter CARC 247 when professional services are rendered and billed within hospital or facility settings — for example, when a physician's services in a hospital outpatient department are included on the facility claim rather than billed separately on a CMS-1500. The key action is to verify the deductible amount is accurate, ensure the patient is not being double-charged across institutional and professional claims, and collect the verified amount from the patient.

Common Causes

How to Resolve

Verify the deductible amount is correct based on the patient's benefit plan, then collect the deductible from the patient.

1. Confirm the deductible amount Verify the PR-247 deductible matches the patient's remaining deductible balance. Check whether other claims processed around the same time may have also applied deductible amounts.
2. Check for split-billing accuracy If services are split between institutional (UB-04) and professional (CMS-1500) claims, ensure the deductible is applied correctly across both claims without duplication.
3. Generate patient statement Bill the patient for the verified deductible amount with clear identification of the date of service, the professional service rendered, and the deductible applied.
4. Contact payer if amount is incorrect If the deductible amount appears wrong — for example, if the patient's deductible was already met — contact the payer with benefit verification showing the correct deductible status and request reprocessing.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-247:

How to Prevent PR-247

• Verify the patient's deductible status before providing services to set accurate financial expectations and facilitate upfront collections
• Ensure proper claim form selection — bill professional services on CMS-1500 and institutional services on UB-04 per each payer's specific requirements
• Coordinate between facility and professional billing departments to prevent deductible allocation errors on split-billed services
• Track patient deductible accumulation across all claims to prevent double-application of deductible amounts
• Train billing staff on the distinction between professional and institutional service components in facility settings

General Prevention

• Verify the patient's deductible status before billing to set accurate expectations for patient cost-sharing on institutional claims
• Ensure proper claim form selection — bill professional services on CMS-1500 and institutional services on UB-04 per payer requirements
• Coordinate between facility billing and professional billing departments to prevent deductible allocation confusion on split-billed services
• Track patient deductible accumulation across claims to ensure accurate deductible application and prevent double-application
• Train billing staff on the distinction between professional and institutional claim components in hospital settings

Related Denial Codes