CARC 119
Benefit maximum for the period reached
The patient has used up a benefit limit for this period or occurrence.
Why you actually get this
- A visit or dollar cap for the plan year has been reached.
- Services from another provider counted toward the same limit.
- The payer's count is wrong.
How to check whether it’s correct
- 01Ask what the limit is and how the payer counted toward it.
- 02Establish whether care from other providers consumed part of it.
- 03Confirm whether the limit resets, and when.
Sometimes worth appealing
Challenge the count where it looks wrong. Where the limit is genuinely reached, the useful action is telling the patient before the next appointment rather than after it.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.