CO-222 Denial Code: Exceeds Contracted Maximum Units

The CO-222 denial code means the claim exceeds the contracted maximum number of hours, days, or units this provider may bill for the period — a limit written into your payer contract, not the patient's benefit plan. Because it carries the Contractual Obligation group, the excess is a provider write-off rather than patient responsibility. CO-222 surfaces most in therapy and ABA, where per-day and per-week unit caps are easy to cross in a high-frequency program.

What is the CO-222 denial code? CO-222 is a Claim Adjustment Reason Code (CARC) indicating the services exceed the contracted maximum number of hours, days, or units allowed for this provider during the period, with the excess assigned to the Contractual Obligation group.

Undeny's Take

CO-222 trips people up because it looks like a medical-necessity or authorization denial, but it is neither — it is a contract-limit denial. The cap lives in your agreement with the payer, capping the hours, days, or units they will pay you for in a given window regardless of how many the patient needs or how many were authorized. That distinction changes the response entirely. You do not win a CO-222 by sending more clinical documentation; you win it by proving the cap was applied wrong, or by managing the calendar so units land inside each period. The strategic fix is upstream: know your contracted caps before you schedule, and renegotiate them if they no longer fit your patient panel.

What CO-222 Means

CO-222 indicates the billed services went past the maximum number of hours, days, or units your contract allows for the period. It is provider-specific and contractual: the limit is tied to your agreement, not to the patient's coverage. The 835 remittance often points to a policy identification segment with the specific limit, so the exact cap and period can usually be traced on the remittance itself.

Why CO-222 Happens

The billed units genuinely exceeded the contracted cap for the day, week, or period.
A scheduling overlap pushed a week's units past the limit even though the total was appropriate.
A billing error reported more units than were actually delivered.
The payer applied the wrong cap or counted units from outside the period.

How to Fix and Appeal a CO-222

Find the specific cap and period on the remittance, then compare it against your contracted limit for that service.
Recount the units actually delivered in the period to confirm whether the cap was truly exceeded.
If the units were over the cap, post the contractual write-off or rebill within the next period as the contract allows; if the cap was misapplied, gather the contract and the unit log.
File a corrected claim or appeal with the supporting documentation, or draft it with the appeal generator.

CO-222 vs Benefit-Maximum Denials

CO-222 is a provider-contract cap, distinct from a patient benefit maximum like CO-119, which means the patient's plan benefit for the service is used up. CO-222 limits what this provider can bill regardless of the patient's remaining benefit; CO-119 limits the patient's coverage regardless of the provider. The fix differs accordingly — contract review for CO-222, benefit verification for CO-119.

Related Codes

CO-222 sits among the limit and coverage codes. CO-119 is a patient benefit maximum, CO-197 is absent prior authorization, and CO-272 means coverage guidelines were not met. Browse the full set under denial codes.

Frequently Asked Questions

What does CO-222 mean?

CO-222 means the claim exceeds the contracted maximum number of hours, days, or units the provider may bill for the period. The limit is set by the provider's payer contract, and the excess is a contractual write-off rather than patient responsibility.

Is CO-222 a benefit limit or a contract limit?

CO-222 is a provider-contract limit, not a patient benefit maximum. It caps what this provider can bill regardless of the patient's remaining coverage, which is why a patient benefit code like CO-119 is a different finding.

Can I bill the patient for a CO-222 amount?

Generally no. CO-222 carries the Contractual Obligation group, so the excess is a provider write-off. The remedy is verifying the cap, rebilling within the allowed period, or appealing a misapplied limit — not billing the patient.

How do I appeal a CO-222?

Trace the specific cap and period on the remittance, recount the units delivered, and if the cap was applied incorrectly, appeal with your contract and unit log. If the units genuinely exceeded the cap, the path is rebilling within the next period or renegotiating the contracted limit.

Informational only — not legal, medical, or billing advice. Always verify against your current payer contract and policy.

Fix CO-222 denials automatically

Undeny checks units against contracted caps and drafts an appeal when the limit is misapplied. Generate an appeal · Browse denial codes