PR 149 denial code

Claim adjustment reason code 149. Often reported as PR 149.

Lifetime 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 149 means

The patient has used up the lifetime limit on this benefit or category of service, so no more is payable.

Some plans cap the total a member can receive over their lifetime for a given benefit or type of service. This code means that cap has already been met, so the plan will not pay for this service.

The balance often becomes the patient's responsibility, but check whether another plan applies and whether the payer counted the limit correctly.

Group codes seen with 149

On a remittance, 149 comes after a group code. These are the ones it is most often reported with:

• PR 149 (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 has reached the plan's lifetime cap for this benefit category.
• Earlier claims for the same benefit used up the remaining lifetime amount.
• The payer counted services toward the limit that may belong to a different category.

What to do next

1. Confirm the lifetime limit and the amount used with the payer.
2. Check whether the patient has secondary coverage that could pay the service.
3. Tell the patient their benefit is exhausted before future services if possible.
4. Appeal if the payer counted services toward the limit in error.

Related codes

• 119 (reason code) Benefit maximum reached
• 27 (reason code) Service after coverage ended