Denial Code CO-119: Benefit Maximum Reached
What Does Code 119 Mean?
Benefit maximum for this time period or occurrence has been reached. The patient has exhausted their allowed visits or dollar amount for this service category.
Group Code CO (Contractual Obligation): The provider has agreed to accept the payer's determination. The patient is generally not responsible for this amount.
Why Does This Happen?
Patient has used all allowed visits (e.g., 20 PT visits per year) or has hit the dollar cap.
How to Resolve It
- 1Verify remaining benefits with the payer
- 2Request an exception or extension of benefits with clinical justification
- 3Schedule a peer-to-peer review if additional services are medically necessary
- 4Inform the patient of their benefit limits
This Denial Is Often Overturned With a Peer-to-Peer Call
When you receive denial code CO-119, the most effective next step is usually a peer-to-peer (P2P) call with the payer's medical director. During this call, you can present your clinical reasoning directly and often get the denial reversed on the spot.
Our free P2P Call Prep Tool generates a structured script based on your specific case, the payer involved, and the denial reason -- so you walk into the call prepared and confident.