CO-119: Benefit maximum reached
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
The payer says you've used up a capped benefit (e.g., therapy visits). Caps are real, but counters are sometimes wrong — and some caps are unenforceable for essential benefits.
CO-119 at a glance
- Code group: CO — Contractual Obligation — in-network providers generally cannot bill you for CO adjustments.
- Who usually fixes it: You (the member).
- Worth appealing? Sometimes — depends on the facts.
What to do about a CO-119 denial
- Ask for the benefit accumulator: exactly which visits/services were counted.
- Check for counting errors (other patients' claims, duplicates, out-of-network visits counted against in-network caps).
- Appeal if the count is wrong, or if the cap conflicts with your plan documents.
Best next read: How to appeal, step by step — the full guide (with a free letter template) for this denial type.
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