CARC Code
119
Benefit Maximum Reached
The insurance plan has paid up to the maximum allowed amount for this service within the specified time period or for this particular occurrence. No additional payment will be made because the benefit limit has been exhausted.
contractualHow to resolve this denial
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about CO-119 — stats, related codes, appeal template
20%
Recovery Rate
5-10 days
Avg. Resolution
Medium
Difficulty
Occasional
Frequency
Payer-Specific Notes
How major payers handle CARC 119 by specialty.
Medicare
Medicare Part A has benefit period limits for inpatient; Part B has no annual maximum
UnitedHealthcare
Mental health visit limits (if any) must comply with parity law; escalate parity violations
Common 835 Combinations
CARC 119 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 119 denials.
We are requesting a review of the benefit maximum applied to claim [CLAIM_NUMBER]. Our records indicate the patient's accumulated benefit is $[YTD_AMOUNT] against a stated maximum of $[MAX]. We believe an error in accumulation tracking has occurred and request an audit of all claims processed for this member in the current benefit year.
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