CO-119
CO · Contractual Obligation
CO-119 Denial Code: Plan's benefit maximum for the period is used up
The patient has hit a plan benefit cap (visits, dollars, or units) for the period. Once the cap is met, more services may be non-covered or patient responsibility - check the plan.
- Group code
- CO - Contractual Obligation
- Code type
- CARC
- Billable to patient?
- Write-off if billed as CO; patient responsibility if billed as PR-119
- Appealable?
- Only if the maximum was miscalculated
- Category
- Coverage & Benefits
- Common pairing
- N362
On a remittance
CAS*CO*119*125.00On a paper EOB it shows as CO-119.What CO-119 means
CO-119 means a benefit limit has been exhausted - for example a cap on physical-therapy visits, behavioral-health sessions, or an annual dollar maximum. Once the maximum is reached, additional services may be non-covered or patient responsibility depending on the plan. Confirm the limit and how much remained at the date of service. Once a benefit max is reached, payers often issue this as PR-119 (patient responsibility) rather than CO, depending on the plan.
Common causes
- The patient reached a visit, dollar, or unit cap for the benefit period.
- A frequency-limited service was provided beyond the allowance.
- An annual or lifetime maximum was exhausted.
How to fix it
- Verify the benefit limit and how much remained at the date of service.
- If the cap was applied incorrectly (for example visits miscounted), request reprocessing.
- If genuinely exhausted, bill the patient where the plan allows, with appropriate notice.
How to prevent it
- Track benefit usage for limited services and warn before the cap.
- Verify remaining benefits at scheduling for capped services.
- Obtain an ABN/notice when a benefit maximum is likely to be exceeded.
Only if the maximum was miscalculatedAppeal only if the maximum was miscalculated (for example the payer counted visits incorrectly). A genuinely exhausted benefit is not overturned; bill per the plan.