CO-119 denial code
The plan says the member has used up the benefit limit for this time period or occurrence.
“Benefit maximum for this time period or occurrence has been reached.”
Start 01/01/1995 · Last modified 02/29/2004 · X12 adjustment reason code list
What it usually means in behavioral health
Visit and day limits on mental health and substance use benefits deserve scrutiny. Under the federal parity rule, for plans it covers, a quantitative limit on mental health or substance use benefits can't be more restrictive than the predominant limit applied to substantially all medical and surgical benefits in the same classification.
The count itself is often wrong: visits from a prior plan year, another provider's visits, or denied services counted against the limit.
Common causes
- Visit or day count includes services from another plan year or product
- Other providers' visits counted toward the same limit
- A mental health or substance use limit more restrictive than the plan's medical limits
- Benefit limit applied that the verification of benefits didn't mention
Correct and resubmit, or appeal?
First verify the count, and ask for reprocessing if it's wrong. If the limit is correct but looks more restrictive than comparable medical limits, appeal on parity grounds and ask for the plan's disclosure. Otherwise the limit stands.
What to do
Ask the payer for the visit history counted against the limit.
Check plan year, product, and provider on each counted visit.
Compare the limit with the plan's medical and surgical limits in the same classification.
Appeal on the count or on parity; document the verification that missed the limit.
Often seen with
- N130
- N362
Got a CO-119 on your desk?
Send us the facts on that one denial — codes, payer, level of care, and dollar amount, no patient information — and within 2 business days we’ll tell you whether to correct or appeal, the deadline to watch, and what evidence would answer it. Free.