Denial Code PR-49: Description, Meaning and How to Fix It
A routine or preventive service is not covered (or was billed with a routine exam), and it is patient responsibility.
Official description
This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine exam.
Common cause
The plan does not cover the routine/preventive service as billed.
How to fix it
Confirm preventive benefits, bill the patient where appropriate, or correct coding if the service was actually diagnostic.
Related denial codes
- CO-96: The service is not covered under the plan. Often paired with a RARC explaining why.
- CO-204: The item or service is not a covered benefit under this plan.
- CO-119: The patient has hit a benefit maximum (visits, dollars, or occurrences) for the period.
- N130: The service is subject to plan restrictions; check the benefit documents.
- CO-45: The amount billed is higher than the payer's contracted (allowed) rate. The difference is a contractual write-off, not a patient balance.
- CO-16: The claim is missing required information or has an error. It is almost always paired with a RARC that names the specific missing field.