CO-119 — Benefit maximum reached
Claim-adjustment reason code 119 · typically reported as CO-119 or PR-119
What it means
The patient has exhausted the benefit for this item/period — dollar cap, visit cap, or lifetime limit.
Why DME claims hit it
- Capped-rental items billed past month 13
- Resupply quantities beyond the plan’s period allowance
- Commercial plans with annual DME dollar caps
How to fix it
- Audit the rental/usage history against the cap before billing
- Past the cap: the balance is typically patient responsibility if properly noticed (ABN for Medicare)
Appeal posture
Only if the payer’s counting is wrong — supply the rental/payment history.
Related denial codes
CO-151 — Frequency / quantity not supportedCO-273 — Coverage guidelines exceededCO-96 — Non-covered charge
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