PR-247PR group · Patient responsibility

PR-247 denial code: deductible for professional service in a facility

PR-247 is the second bill patients do not expect, and explaining it early prevents most of the calls.

PR-247 applies a deductible to the professional component of care delivered in a facility. It is distinct from any deductible applied to the facility's own charge.

What PR-247 means

Facility care generates two claims: the facility's and the professional's. Where the plan applies deductibles separately, the patient encounters cost sharing twice for what they experienced as one episode. The amount is usually correct and the surprise is the problem — which makes this a communication task more than a billing one. Patients told in advance that they will receive two bills complain far less than patients who discover it.

Why PR-247 fires

  • The plan applies deductibles separately to facility and professional services.
  • The member had not met the professional deductible at the time of service.
  • Two claims arose from one episode and each carried cost sharing.

Is PR-247 worth appealing?

Rarely an appeal — usually a fix

The amount is generally correct. What is worth doing is explaining it — patients who are told to expect a separate professional bill are far less likely to dispute it.

PR-247 — frequently asked

Why are there two deductibles?
Because facility and professional services are billed separately and some plans apply cost sharing to each. One episode of care generates two claims.
Should I explain this in advance?
Yes, particularly for scheduled facility procedures. The most common complaint about this code is surprise rather than amount.

Related guides

PR-248 · Patient responsibilityPR-1 · Patient responsibilityPR-2 · Patient responsibility

Sources

Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.

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