PR-96: Non-covered charge(s).
The service billed is simply not a covered benefit under this plan. Code 96 is a broad, generic non-coverage flag and is almost always paired with a remark code that explains the specific reason, such as a benefit exclusion, non-covered item, or missing modifier.
What the group code means
- PR
- Patient Responsibility. The amount may be billed to the patient.
This CARC is reported under more than one group code depending on the payer and the circumstances: PR, CO.
Why it fires
- The billed item or service is excluded from the plan's benefit design
- A required modifier or code combination that would make it covered was missing
- The remark code paired with 96 points to a specific reason such as cosmetic, experimental, or not medically necessary
Corrective actions, ranked
- 1
Read the paired remark code first
Code 96 alone is not actionable. The remark code tells you the real reason for non-coverage.
- 2
Verify the benefit
Check the patient's plan documents to confirm whether the service is genuinely excluded or if the claim was coded in a way that triggered a false exclusion.
- 3
Correct and resubmit or bill the patient
If it is a coding issue, fix and resubmit. If it is a true exclusion, move the balance to patient responsibility per the payer contract.
Is it worth appealing
Appeal only when the remark code paired with 96 indicates a fixable issue, such as a wrong code or missing modifier, rather than a genuine plan exclusion.
Remark codes that arrive with it
A RARC carries the detail behind PR-96. These are the ones our dataset records alongside it.
Other denial codes to check
Codes that share a remark code with this one, or that are reported under the same group code.
- PR-204This service/equipment/drug is not covered under the patient's current benefit plan
- PR-167This (these) diagnosis(es) is (are) not covered.
- PR-50These are non-covered services because this is not deemed a 'medical necessity' by the payer.
- PR-151Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
- PR-1Deductible Amount
- PR-2Coinsurance Amount
Retrieved 2026-07-18.
Do not let this happen again
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Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.