CO 222 denial code

Claim adjustment reason code 222. Often reported as CO 222.

Over the contract's volume cap

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 222 means

Your contract caps how many hours, days or units you can bill in a period across all patients, and this claim went past it.

This is a provider level limit, not a patient level one. The contract caps how much of a service you can bill in a time period, and this claim crossed that cap.

It appears in programs that buy a set volume of service, such as some home care or contracted staffing arrangements. A policy reference may be on the remittance.

Group codes seen with 222

On a remittance, 222 comes after a group code. These are the ones it is most often reported with:

• CO 222 (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.

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 provider's total hours or units for the month passed the contract cap.
• Several claims processed together and the later ones fell past the limit.
• The contract cap was lowered or renewed with different limits.

What to do next

1. Review the contract to confirm the maximum and the period it covers.
2. Total the units already paid in the period to see whether the cap was really reached.
3. Ask the payer to reprocess if earlier claims were counted in error.

Related codes

• 119 (reason code) Benefit maximum reached
• 45 (reason code) Charge exceeds the allowed amount
• 198 (reason code) Authorization limits exceeded