CARC 119 — The patient has used up the maximum benefit allowed for this service within the

CARC 119PR · Patient Responsibility

The patient has used up the maximum benefit allowed for this service within the applicable time period, such as an annual visit limit.

Common causes: The plan caps the number of visits or dollar amount for a service type per year, and the patient has already reached that cap.
Suggested fix: Confirm the benefit period and limit with the payer; if it's exhausted, the patient is typically responsible for further services in that period.

Related Patient Responsibility codes

1The billed amount was applied to the patient's plan deductible instead of being paid by the payer.167The specific diagnosis code(s) on this claim aren't covered under the patient's plan.177The patient doesn't currently meet the plan's eligibility criteria for this benefit.187This amount was or should be paid from the patient's consumer-directed spending account, such as an HSA or FSA, rather than by the payer.2This portion of the claim represents the patient's coinsurance share, the percentage of the allowed amount they are responsible for under their plan.200The service date falls within a period when the patient's coverage had lapsed.201The patient is responsible for this amount under a legal set-aside arrangement, commonly seen in workers' compensation Medicare Set-Aside cases, rather than the payer.202This charge is for a personal comfort or convenience item or service that isn't covered by the plan.

Frequently asked questions

What does CARC 119 mean?

The patient has used up the maximum benefit allowed for this service within the applicable time period, such as an annual visit limit.

How do I resolve CARC 119?

Confirm the benefit period and limit with the payer; if it's exhausted, the patient is typically responsible for further services in that period.

Why does CARC 119 happen?

The plan caps the number of visits or dollar amount for a service type per year, and the patient has already reached that cap.

CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.