PR-66PR group · Patient responsibility

PR-66 denial code: blood deductible

PR-66 is a benefit design most billers meet once and then have to look up every time after.

PR-66 applies the blood deductible, a separate cost-sharing provision covering the first units of whole blood or packed red cells a member receives in a benefit year.

What PR-66 means

The provision predates modern benefit design and survives in Medicare and in plans that mirror it. It is distinct from the general deductible and is measured in units rather than dollars. It can be satisfied by replacement — blood donated on the member's behalf — which is the one route that removes the charge, and it is the fact patients almost never know.

Why PR-66 fires

  • The member received blood within the deductible units for the year.
  • The units were not replaced by donation.
  • The provider did not report replacement that occurred.
  • The plan mirrors Medicare's blood deductible provision.

Is PR-66 worth appealing?

Rarely an appeal — usually a fix

The provision is real and correctly applied in most cases. The one avenue is replacement — blood donated on the member's behalf satisfies it — and it needs reporting to the payer.

PR-66 — frequently asked

What is a blood deductible?
A cost-sharing rule applying to the first units of blood in a benefit year, separate from the general deductible and counted in units rather than dollars.
Can it be avoided?
By replacement. Blood donated on the member's behalf satisfies the deductible, and it has to be reported to the payer to take effect.

Related guides

PR-1 · Patient responsibilityPR-2 · Patient responsibilityPR-3 · 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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