CARC Code
222
Provider Period Maximum Exceeded
The provider has billed more hours, days, or units than their contract allows for this time period. This limit applies to the provider overall, not to any individual patient.
contractualHow to resolve this denial
Review contracted limits; appeal with updated care plan documentation if limit was incorrectly applied
- 1
Pull the original claim and review the denial reason and any RARC codes
- 2
Research the payer's policy for CARC 222 to understand the basis for denial
- 3
Gather supporting documentation addressing the denial reason
- 4
Submit a formal appeal with the documentation within the plan's appeal window
- 5
Follow up on the appeal within 30 days and document all communication
▶✓ 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-222 — stats, related codes, appeal template
35%
Recovery Rate
21-45 days
Avg. Resolution
Hard
Difficulty
Occasional
Frequency
Payer-Specific Notes
How major payers handle CARC 222 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Appeal Letter Template
Generic appeal template for CARC 222 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 222 indicating: "Exceeds contracted maximum number of hours/days/units by this code and modifier ." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
Need to resolve this denial?
Get a step-by-step resolution plan with payer-specific guidance and appeal letter generation.
Resolve this denial →