PR-248PR group · Patient responsibility

PR-248 denial code: coinsurance for professional service in a facility

PR-248 is the coinsurance counterpart to the separate professional deductible, and it lands the same way.

PR-248 applies coinsurance to the professional component of facility-based care, separately from coinsurance on the facility charge.

What PR-248 means

Coinsurance is a percentage of the allowed amount, so the professional share is calculated on the professional allowed amount rather than on the episode as a whole. Patients who have satisfied their obligation on the facility bill are frequently surprised to owe a percentage on the professional one. Where the professional was out of network at an in-network facility, surprise-billing protections may cap what the patient owes, and that is worth checking before collection.

Why PR-248 fires

  • Coinsurance applies separately to the professional component.
  • The member owes a percentage of the professional allowed amount.
  • The professional was out of network at an in-network facility.

Is PR-248 worth appealing?

Rarely an appeal — usually a fix

Generally correct as applied. The exception worth checking is an out-of-network professional at an in-network facility, where surprise-billing protections may limit what the patient can be charged.

PR-248 — frequently asked

How is it calculated?
As a percentage of the professional allowed amount, not of the whole episode. That is why it appears even after the facility coinsurance was satisfied.
What about an out-of-network physician at an in-network hospital?
Federal and many state surprise-billing protections cover that situation and can limit the patient's liability to in-network cost sharing. Check before billing.

Related guides

PR-247 · Patient responsibilityPR-2 · Patient responsibilityPR-45 · Allowed amount

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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