What does CARC 119 mean?

CARC 119 means 'Benefit maximum for this time period or occurrence has been reached.' The patient has used all the benefits their plan allows for this service.

Can CARC 119 be appealed?

Sometimes. If the patient's plan has a medical necessity exception and you can document the need, an appeal may succeed. Otherwise, the service is the patient's responsibility.

How can I prevent CARC 119 denials?

Verify benefits and remaining visits before every appointment in specialties with visit limits. Have the patient sign an ABN when approaching the limit so you can bill them if needed.

CARC 119 Denial Reason: Benefit Maximum Reached

Official CMS Definition

"Benefit maximum for this time period or occurrence has been reached."

Group Code: CO, PI, or PR Category: Benefit Maximum/Limitation Risk Level: High Appealable: Rarely

What CARC 119 Actually Means

Claim Adjustment Reason Code (CARC) 119 is a benefit limit denial. The patient's insurance plan allows a specific number of visits, services, or dollar amount for a particular type of care within a defined time period, and that limit has been exhausted. The payer is not questioning whether the service was medically necessary. They're telling you the plan simply won't pay for any more of that service this year.

Common services that hit CARC 119: physical therapy visits, chiropractic adjustments, behavioral health sessions, home health visits, and durable medical equipment.

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CARC 119: Benefit Maximum Reached

What CARC 119 Actually Means

Read the full breakdown — free