EOB denial code · CO group
CO-119: Benefit Maximum Reached — Meaning & Who Pays
CO-119 means the plan's benefit maximum for that service or category has been reached for the benefit period (usually the plan year). Common maxed-out benefits include chiropractic visits, physical therapy sessions, occupational therapy, acupuncture, and durable medical equipment. Once the cap is hit, the plan pays nothing until the next benefit period — but the amount you owe depends on whether the provider is under a contractual discount.
What “CO-119” means on your EOB
Benefit maximum for this time period or occurrence has been reached.
Who pays? CO — Contractual Obligation
CO (contractual) — the plan applied its max. You may owe the provider's full charge unless a negotiated/contracted rate applies, so check the EOB's allowed amount before paying.
What to do next: Before appealing, verify the count: how many visits/sessions were applied this period? If the plan counted a denied or rescheduled session, or applied the cap to a service in a different category, an appeal with visit history and EOBs wins. If the cap is legitimately hit, appeals are generally futile — the benefit is contractual, not a coverage error. Check whether a secondary plan or spending account can pick up the remainder.
Why this denial happens
- Annual visit caps (e.g., 20 PT sessions, 15 chiropractic visits) were consumed earlier in the plan year.
- The benefit period rolled over and the maximum is per calendar year.
- A claim was submitted under the wrong benefit category or counted twice.
- DME or a specific service category has its own dollar maximum that was exhausted.
What to do now
- Review your EOB history: count the paid visits/sessions this benefit period.
- Compare to your policy's benefit schedule (look for 'limit: X visits per year').
- If the count seems wrong (double-counted cancellation, wrong category), appeal with the visit log.
- If the max was used up legitimately, ask your provider about spacing visits into the next benefit period or whether a different code/category applies.
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Generate an appeal letter →What benefits have annual maximums?
Chiropractic, PT/OT, acupuncture, speech therapy, and often DME or fertility services are common capped benefits. Major medical care (hospital, surgery, emergency) is protected from annual dollar caps by the ACA.
Am I on the hook for the full fee when the maximum is reached?
It depends on the provider contract. In-network providers usually still reduce the charge to the negotiated rate even when the benefit is exhausted. Verify the allowed amount on the EOB before paying the provider's bill.
Does the maximum reset?
Yes — most caps reset at the start of the next benefit period (calendar year or plan anniversary). Check your plan's 'benefit period' definition on the summary of benefits.