What does CO-119 mean?
CARC code 119 means the patient has reached their benefit maximum for the time period (visit limit or dollar limit). In behavioral health, this is an important code to understand because the Mental Health Parity and Addiction Equity Act (MHPAEA) prohibits health plans from imposing more restrictive limitations on mental health and substance use disorder benefits than on medical/surgical benefits. If the plan has a visit limit for behavioral health that does not exist for comparable medical services, you may have grounds for a parity-based appeal. Include clinical documentation showing continued medical necessity and reference MHPAEA. Overturn rate is approximately 30%.
How to appeal CO-119
Check the RARC code
The RARC (Remittance Advice Remark Code) on your ERA provides specific details about why the claim was denied. This tells you exactly what needs to be fixed.
Gather clinical documentation
Compile clinical notes, treatment plans, and any relevant guidelines that support the medical necessity of the service provided.
Submit a formal appeal letter
Write a detailed appeal letter that references clinical guidelines, payer policies, and includes supporting documentation. Submit via the payer's preferred method (fax, portal, or mail).
Key notes for behavioral health
Visit/dollar limit exceeded. Appeal if medically necessary — Mental Health Parity Act may apply.