Denial codes / PR-35
Denial code 35PR-35: Lifetime maximum reached
Lifetime benefit maximum reached.
What to doUsually the patient's share
Often recoverableUsually not
The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.
Why dental offices see it
- The plan's lifetime maximum for a benefit (often orthodontics) is used up.
What to do
- Confirm the lifetime maximum and how much was used.
- If correct, bill the patient with the EOB.
Stop it next time
Check remaining lifetime orthodontic benefit before starting treatment.
How many PR-35 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.
Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.