CARC · CO group
CO-119
Benefit maximum for this time period or occurrence has been reached
Contractual obligation; provider write-off unless appealed
- What it means
- The patient exhausted a visit or dollar cap for the period.
- Likely cause
- Annual session limits under the plan, common with EAP and some commercial behavioral riders.
- How to fix it
- Track visit counts at scheduling. Request an extension or transition to self-pay before the cap is hit, not after.
- Revenue impact
- Rarely recoverable; preventable with benefit tracking.
- benefit maximum
- EAP
- prevention
Related codes
Early access
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