Denial code · CARC 119
CARC 119 (PR-119 or CO-119): benefit maximum reached for BH services
What CARC 119 means for session limits, day limits and ABA caps, how parity rules restrict visit caps on mental-health and SUD benefits, and how to check and challenge the count.
By the ClaimParrot editorial team · Who we are · Reviewed · 4 min read · 6 cited sources
Quick answer
CARC 119 means the plan says a benefit limit for the period has been reached, such as a yearly visit cap, a day limit or a lifetime maximum, so it stops paying. In behavioral health, check two things first: whether the count is right, including visits to other providers, and whether a mental-health or SUD limit is stricter than the plan's medical limits.
| Item | Detail |
|---|---|
| Code | CARC 119 · Active on the X12 list; checked October 14, 2026 |
| Plain meaning | The plan's limit on this benefit, such as visits or days per year or a lifetime maximum, has been reached, so the payer stops paying for more. |
| Group codes seen | PR (patient responsibility), CO (contractual obligation) |
| Common remark codes | N130, N362, N640 |
| Where it shows up in BH | Outpatient therapy, Inpatient psychiatry, Residential SUD (ASAM levels), ABA therapy |
| Usual next step | Verify the count; then request an exception or appeal the limit |
| Related codes | CARC 151, CARC 198, CARC 96 |
What does CARC 119 mean?
CARC 119 is a benefit-limit denial. The payer is not judging the care, only counting it against a cap in the plan: visits per year, days per stay or year, hours, or a lifetime maximum. The disputes are about whether the count is accurate and whether the cap is allowed at all.
In group health plans, a numerical limit on mental-health or SUD benefits may not be more restrictive than the predominant limit applied to substantially all medical and surgical benefits in the same classification (29 CFR 2590.712(c)(2)). The parity checker helps frame that question.
What do PR-119 and CO-119 mean for who pays?
Both forms occur. PR-119 means the plan treats services past the cap as the member's cost, so billing the patient may be allowed within your contract and state rules. CO-119 means your contract keeps the amount with you. Either way, verify the count before anyone pays.
| Group + reason | What it signals | Who usually carries the balance |
|---|---|---|
| PR-119 | Limit reached; plan assigns further services to the member | Patient, within your contract and state rules |
| CO-119 | Limit reached; contract bars billing the member | Provider |
Which remark codes come with CARC 119?
Remark codes with 119 point to the plan rule or the count behind the limit.
| Remark code | What it adds | What to check |
|---|---|---|
| N130 | The plan's benefit documents limit this service; check them for the restriction that applied. | The wording of the limit in the benefit documents |
| N362 | The days or units billed are more than the payer accepts as a maximum. | The units or days counted against the maximum |
| N640 | The number or frequency billed goes past what was approved or allowed for the period. | The period used: calendar year, plan year or rolling |
Where does CARC 119 show up in behavioral health?
In behavioral health, 119 appears where plans still count: annual therapy visits, residential or inpatient day limits, ABA hours, testing hours and some Medicaid service limits. Medicare has its own: a 190-day lifetime limit on care in freestanding psychiatric hospitals, which does not apply to certified psychiatric units in hospitals.
| Care setting | Typical trigger | Check first |
|---|---|---|
| Outpatient therapy | Annual visit cap reached, sometimes counting visits at another practice | The plan's count, by date and provider |
| Inpatient psychiatry | Medicare's 190-day lifetime limit in freestanding psychiatric hospitals reached | Prior psychiatric hospital days in the patient's history |
| Residential SUD (ASAM levels) | Day limit per stay or per year reached | Plan language and the comparable medical limit |
| ABA therapy | Hour or dollar cap in the plan or a state mandate reached | The cap's source and any exception process |
Corrected claim, reconsideration or appeal: which fits CARC 119?
Verify first: ask the payer for the count behind the denial and compare it with your records, because shared counters can include other providers or misdated services. If the count is right, ask about exceptions or prior authorization for more visits, and appeal if the limit itself conflicts with parity rules.
- 01Request the plan's count: which dates and providers it counted against the limit.
- 02Correct the count if services were miscounted, duplicated or belong to another benefit.
- 03If the limit applies only to MH/SUD benefits or is stricter than medical limits, appeal and ask for the plan's parity analysis.
What evidence resolves a CARC 119?
The evidence is the count and the rule. Show the plan's own count against your records, then the plan language that sets the limit. For a parity argument, the comparison is with limits on medical and surgical benefits in the same classification, which you can ask the plan to explain.
- The plan's count of visits or days, by date and provider
- Your own dated visit list for the period
- The benefit language that sets the limit
- The plan's medical and surgical limits in the same classification
- Any exception or prior-authorization route for more visits
How do Medicare, Medicaid and commercial plans differ on CARC 119?
Program rules differ. Medicare's best-known behavioral-health limit is the 190-day lifetime limit for freestanding psychiatric hospitals; Medicaid programs set service limits by state rule; employer plans set limits in the plan document, where parity rules constrain caps on mental-health and SUD benefits.
| Program | What differs |
|---|---|
| Medicare (Original) | 190 days of care in freestanding psychiatric hospitals per lifetime; the limit does not apply to certified psychiatric units in hospitals. |
| Medicaid | States set limits and thresholds. Ohio Medicaid, for example, allows one psychiatric diagnostic evaluation per code per year per billing agency and requires prior authorization for more. |
| Commercial and ERISA plans | Visit and day limits on MH/SUD benefits may not be stricter than the predominant limit on medical benefits in the same classification. |
PR-119 on therapy visit 21
A fictional practice's claim for a member's 21st therapy visit of the year came back PR-119; the plan summary listed a 20-visit outpatient limit.
The biller requested the plan's count and found four visits at a previous practice plus one duplicate. Without the duplicate the member was under the limit, and the plan reprocessed the claim. The practice also asked whether the plan's medical outpatient benefits carried a comparable cap.
Names, dates, payers and amounts are invented for illustration.
What a ClaimParrot packet does here
- When CARC 119 needs an appeal rather than a corrected claim, an appeal packet answers the payer's stated reason.
- A person checks every packet: $29, or $99 for level of care, and the first is free (pricing).
- No remittances, records or PHI are sent: just the reason and a de-identified summary (Trust & security).
Every draft is reviewed and approved by your team. ClaimParrot does not make medical-necessity determinations or give legal advice.
Frequently asked questions
Can a plan cap mental-health therapy visits?
Only within parity limits. In group health plans, a visit cap on MH/SUD benefits cannot be stricter than the predominant cap on medical and surgical benefits in the same classification.
Can we bill the patient after a PR-119?
PR assigns the amount to the patient, so billing may be allowed within your contract and state rules. Check the count first: if the limit was miscounted, the plan should pay, not the patient.
Do visits at another practice count toward the limit?
They can, when the limit is per member rather than per provider, which is why the plan's own count matters. Ask for the dates and providers it counted.
Does Medicare's 190-day limit apply to psychiatric units in general hospitals?
No. The 190-day lifetime limit applies to care in freestanding psychiatric hospitals, not to certified psychiatric units within hospitals.
Primary sources and references
- Claim Adjustment Reason Codes (CARC) code list · X12 · checked
- Remittance Advice Remark Codes (RARC) code list · X12 · checked
- 29 CFR 2590.712: mental health parity, including criteria disclosure in paragraph (d) · eCFR · checked
- Statement regarding enforcement of the 2024 MHPAEA final rule (May 2025) · U.S. Department of Labor, EBSA · checked
- MLN1986542, Medicare & Mental Health Coverage (March 2026) · CMS Medicare Learning Network · checked
- Ohio Medicaid Behavioral Health Provider Requirements and Reimbursement Manual, v1.28.1 (March 2026) · Ohio Department of Medicaid · checked
General information, not legal or medical advice. Payer rules change; confirm deadlines and requirements in the notice and the plan documents. Read our editorial policy.
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