CARC Code
35
Lifetime Benefit Maximum Reached
The patient's insurance policy has a maximum dollar amount or service limit that can be paid over their entire lifetime, and that limit has been fully used. No further benefits are available under this policy for covered services.
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-35 — stats, related codes, appeal template
35%
Recovery Rate
21-45 days
Avg. Resolution
Hard
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 35 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Common 835 Combinations
CARC 35 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 35 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 35 indicating: "Lifetime benefit maximum has been reached.." 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.
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