Denial code · group CO
CO-119: The member has used up the plan's limit on visits, units or dollars for this service
Short answer
CO-119 means the member has reached a benefit limit for this service: a visit, unit or dollar maximum, or a once-per-lifetime rule. The care is not in question. Check the payer's accumulator: visits used elsewhere or miscounted land here too. If the cap is real, a CO line is not billed to the patient; where the plan makes the member responsible and the patient was told, ask the payer to reprocess under PR first.
Look up other codes in the denial code library.
Last reviewed by the Remitwright billing team. Editorial policy
Group CO means contractual obligation: the balance is written off, not billed to the patient. The number is the reason; the two-letter group says who carries the balance.
Remark codes that usually come with CO-119
- M86
- Too little time has passed since the payer paid for the same or a similar service
- N117
- The plan pays for this service a single time per patient, ever
- N113
- The plan pays for just one initial visit with the same clinician or group, and this was not the first
Common causes
A visit cap for the plan year
Therapy, chiropractic and behavioral health benefits often carry a fixed number of visits per plan year or calendar year. The denial lands on the first visit past the cap, and every visit after it, until the year resets.
Visits used at another provider
The patient saw another clinic earlier in the year, or sees two disciplines that share one benefit, and your count is lower than the payer's. The intake question about visits was answered with the plan's total, not the remaining number.
A dollar or unit maximum
Equipment rentals that reach the purchase cap, supplies limited to a quantity per period, or a dollar maximum for a benefit category. The payer stops paying when the accumulator hits the limit, regardless of medical need.
A once-per-period or once-per-lifetime rule
One initial visit per provider or group, one preventive service per year, or a service covered once in a lifetime. N113 and N117 say which. A second one from the same group denies even when a different clinician performed it.
A payer counting error
Denied visits counted as used, a different benefit category counted against this one, or the plan year misread as the calendar year. The accumulator is wrong and the denial with it.
How to fix it and resubmit
- 1
Pull the accumulator
Call the payer or use the portal to get the number of visits or units used, the dates, the providers and the period the limit applies to. Compare it to your own records and to what the patient reported at intake.
- 2
Dispute a wrong count
If the payer counted denied visits, visits from another benefit, or the wrong period, ask for reprocessing with the accumulator detail and the dates in question. Put the request in writing if the call does not resolve it.
- 3
Ask about extensions
Some plans allow more visits on medical necessity review, with a progress note and plan of care. Where the plan offers it, request the extension before the next visit, not after the next denial.
- 4
Check the group code and the contract
CO-119 puts the balance on you; PR-119 puts it on the patient. If the plan's rules make the member responsible once the cap is reached and the patient was told, ask the payer to reprocess under PR before you bill.
- 5
How to prevent it
- Benefit verification that records the remaining visits or units for the period, the period's start date and whether other providers share the benefit, at intake and again mid plan of care
- A visit counter in the practice management system per patient, per payer and per benefit period, with an alert a few visits before the cap
- A financial notice signed at intake that explains what happens when the cap is reached, with the remaining count written on it
- A plan-year reset calendar per payer so visit counts are reset on the right date, not on January 1 for every plan
A CO-119 on a physical therapy plan of care
A physical therapy clinic verifies a patient's benefit at intake and records 30 visits per plan year. The patient had already used 12 visits at another clinic earlier in the year, which the intake call did not ask about. The clinic's nineteenth visit denies CO-119. The payer's accumulator shows 30 visits used. The patient signed the clinic's financial policy, which says visits past a plan's cap are hers to pay, but nobody told her how many visits remained. Because the plan allows member billing after the cap, the clinic asks the payer to reprocess the visit under PR-119 and bills her once the remit shows PR. It also changes its intake script to ask for the remaining count and the other providers who have billed the benefit. This is a hypothetical example.
Official text: the X12 claim adjustment reason code list. The meaning above is our paraphrase for billers; the list is the authority.
FAQ
Questions about CO-119
Is CO-119 a medical necessity denial?
Can I bill the patient after a CO-119?
The patient says they have not used that many visits. What now?
Does the limit reset on January 1?
What is the difference between CO-119 and CO-151?
Next step
Seeing a lot of CO-119?
Tell us the payer and the volume. Three quick questions, no patient data, a written answer from a biller who works that queue.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how to work claim denials. You can also download the sample weekly report (PDF).