CO-119: Lifetime Benefit Maximum Reached
CO (Contractual Obligation)What is CO-119?
CO-119 is a Contractual Obligation code indicating the patient has reached the lifetime benefit maximum for this service category. Unlike CO-39 (annual maximum), CO-119 means the lifetime cap has been exhausted.
Why Does CO-119 Occur?
- Patient has reached the lifetime dollar maximum for the benefit category.
- Lifetime visit limit exhausted (e.g., lifetime maximum for transplant-related services).
- Plan's lifetime cap for a specific condition has been met.
How to Fix CO-119 Denials
- Verify the patient's lifetime accumulators on the payer portal.
- If the lifetime maximum is incorrect, appeal with documentation of prior claims and accurate accumulator totals.
- Inform the patient of their options: self-pay, financial assistance, or alternative coverage.
- Check whether the ACA lifetime maximum prohibition applies to the patient's plan (grandfathered plans may still have lifetime caps).
CO-119 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-119, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-119
What does CO-119 mean?
CO-119 indicates lifetime benefit maximum reached. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-119 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-119 denials before submission with lifetime benefit tracking. See how pre-submit claim scoring works.