CARC 222CO · Contractual Obligation
The service exceeds the maximum hours, days, or units this provider is contractually allowed to bill in the given period.
- Common causes
- A provider-specific contractual cap on service volume was exceeded.
- Suggested fix
- Review the contract terms for volume limits; if the extra units were medically necessary, appeal with documentation, or confirm billing didn't duplicate units in error.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 222 mean?
The service exceeds the maximum hours, days, or units this provider is contractually allowed to bill in the given period.
How do I resolve CARC 222?
Review the contract terms for volume limits; if the extra units were medically necessary, appeal with documentation, or confirm billing didn't duplicate units in error.
Why does CARC 222 happen?
A provider-specific contractual cap on service volume was exceeded.
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.