Official CARC description: “Benefit maximum for this time period or occurrence has been reached.” Here’s what it actually means, why it fires, and how to get the claim paid.
The patient exhausted a capped benefit — therapy visit caps, annual dollar maximums, or per-occurrence limits. Verify the payer's counting before shifting liability.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Also written: CO-119, CO119, “denial code 119”, “119 denial code” or “reason code 119” — same CARC, different ERA formatting.
Reason code 119 also appears under another group on the ERA. The number is the reason; the prefix decides who absorbs the money. This page covers CO 119 (Contractual Obligation). If your ERA shows a different prefix, use the matching page:
Request the benefit accumulator detail — what claims consumed the max
If duplicates or other-provider errors inflate it: dispute the accumulator
Medicare therapy: append the KX modifier when medically necessary above threshold
If genuinely exhausted: bill the patient with the plan's member-liability rules
Appealable on two fronts: accumulator errors (attach the corrected count) and medical-necessity exceptions above caps where the plan or Medicare allows (KX pathway, plan exception process).
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
The official CARC description for CO 119 is: “Benefit maximum for this time period or occurrence has been reached.” In practice: The patient exhausted a capped benefit — therapy visit caps, annual dollar maximums, or per-occurrence limits. Verify the payer's counting before shifting liability.
Denial code 119 under the CO group (Contractual Obligation) means: Benefit maximum for this time period or occurrence has been reached. The number is the reason; the CO prefix decides who is liable — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Yes. CO 119, CO-119, CO119 and “denial code 119” are the same CARC — clearinghouses, payer portals and PM systems just print it differently. Only the group prefix (CO, PR, OA or PI) changes the meaning, because it changes who has to absorb the amount.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Appealable on two fronts: accumulator errors (attach the corrected count) and medical-necessity exceptions above caps where the plan or Medicare allows (KX pathway, plan exception process).
The number 119 is the same reason code in both — what changes is the liability group. PR 119 is Patient Responsibility. CO 119 is Contractual Obligation, so the provider absorbs it. Check the prefix on the ERA before you write anything off or bill the patient — a mis-grouped 119 is one of the more winnable appeals.