What is CO119 denial code Maximum Benefit exhausted?
CO119 denial code-Maximum benefit Exhausted denial occurs when the patient exceeds the allowed limit for the service at a particular time. In general insurance company has a limit of service allowed as per the patient’s plan. if the allowed services exceeded insurance will deny the claim stating the limit already exhausted and the additional service not applicable per insurance policy. Consequently, in some cases, insurance will never pay, and this when you can look for secondary insurance or bill the patient directly.
Types of Exhaustion in CO119 denial
Let’s say the allowed unit(CPT) 5 and the patient getting 8 units for different treatment. In this case, the allowed unit exceeded as per the insurance guidelines under the patient’s plan.
In terms of the visits, let’s say a patient has 24 visits per annum for a particular treatment, and now the patient completed all 24 visits going for another 10 visits within a year. so-called maximum visit exhausted.
The patient is allowed to get treatment up to $2000.00 bill Per annum. now the patient completed the allowed amount. Again opting for a service of an extra $500.00. Then obviously this will deny under the maximum allowed amount exceeded.
Questions for CO119 denial code (Maximum benefit exhausted)
In short, for Maximum benefit exhausted/services maxed out Scenario Either, check the eligibility of the patient and find the secondary payor who covers the patient and you can bill the secondary payer of the patient or you can create an invoice to bill the patient directly confirming the Prior notice letter was sent to the patient.