PR-1 — Applied to the patient’s deductible
Claim-adjustment reason code 1 · typically reported as PR-1
What it means
Not a true denial: the allowed amount was applied to the patient’s deductible, so the payer paid $0 and the balance is patient responsibility.
Why DME claims hit it
- January–March claims, before the Part B deductible is met
- Capped-rental month 1 hitting a fresh deductible year
How to fix it
- Bill the patient (or secondary payer) for the deductible amount
- Verify the remaining deductible before delivery for big-ticket items so the patient isn’t surprised
Appeal posture
Nothing to appeal — collect from the patient or cross over to the secondary payer.
Related denial codes
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