CO 119 denial code

Claim adjustment reason code 119. Often reported as CO 119 or PR 119.

Benefit maximum reached

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What 119 means

The patient has used up the plan's benefit limit for this service, either for the benefit period or for a single episode.

The plan caps how much it pays, or how many visits or units it covers, for this kind of service in a benefit period or over a lifetime. Earlier claims used up that limit, so this one was reduced or not paid.

With CO, the payer is saying the provider cannot collect beyond the cap under the contract; with PR, the patient usually owes it. Visit limits on therapy, chiropractic and behavioral health are frequent triggers. Confirm the count, since claims from other providers also use up the benefit.

Group codes seen with 119

On a remittance, 119 comes after a group code. These are the ones it is most often reported with:

• CO 119 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
• PR 119 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.

The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.

Common causes

• The patient reached the plan's yearly visit limit, such as for physical therapy or chiropractic care.
• A dollar maximum for a benefit category was met by earlier claims.
• Claims from another provider counted against the same benefit limit.
• The payer counted visits under the wrong benefit category or year.

What to do next

1. Check remaining benefits and the limit period with the payer for the date of service.
2. Ask for the claim history behind the count if you think visits were miscounted.
3. Request a benefit exception or medical necessity review if the plan allows extra visits.
4. Use the group code and contract to decide whether any balance can go to the patient.
5. Track visit counts at scheduling so patients are told before the limit is reached.

Related codes

• 96 (reason code) Service not covered by the plan
• 27 (reason code) Service after coverage ended
• 204 (reason code) Not covered under the patient's plan
• 1 (reason code) Amount applied to the deductible