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CO-149 Denial Code: Lifetime Max for a Benefit Category

CO-149 means the patient has reached the lifetime benefit maximum for this particular service or benefit category. Unlike an annual limit, the cap does not reset. The payer will not pay more for that category, though other benefits under the plan may still be available.

Quick facts

Code
CO-149 (CARC 149)
Status
Active In use since October 31, 2002.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The patient is responsible because the lifetime category limit is exhausted. Bill according to your financial policy and contract.
  • CO (Contractual Obligation): The payer holds the provider responsible, for example because the contract requires verifying limits or bars billing members. Check the contract before billing the patient.
Official description
Lifetime benefit maximum has been reached for this service/benefit category.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-149 means

CARC 149 reads lifetime benefit maximum has been reached for this service/benefit category. Some plans limit how much, or how many times, they will ever pay for a specific category of care, such as a one-time procedure or a lifetime cap on a particular benefit. Once reached, that category is closed for the life of the coverage.

The difference from its neighbors matters: PR-119 is a limit that resets each period, and CO-35 is a lifetime maximum for the whole plan. CARC 149 is narrower: only this category is exhausted.

Example: a plan pays for a certain procedure once per lifetime. A patient who had it covered before has it again, and the claim returns CO-149 with remark N117.

Common causes

  • A once-per-lifetime service billed again.
  • A lifetime dollar or visit cap on a benefit that is not an essential health benefit, such as some adult dental, hearing, or infertility benefits.
  • The payer counting prior claims from another provider or an earlier plan with the same carrier.
  • A procedure coded as a service that has a lifetime limit when a different code better describes what was done.

How to fix it

  1. Ask the payer for the service history that counts toward the limit, including dates and providers.
  2. Check the coding. If a different code accurately describes the service, send a corrected claim with resubmission code 7 in box 22.
  3. Appeal if prior claims were counted wrongly, or if the limit appears inconsistent with the plan’s obligations for essential health benefits.
  4. If the limit is valid, bill per the group code: patient responsibility under PR, or write-off under CO when your contract requires it.
  5. Check secondary coverage, which may cover the service after the primary’s category limit.

How to prevent it

  • Ask about lifetime limits for high-cost or once-only services during benefit verification.
  • Record one-time services in the patient’s history so staff know before scheduling a repeat.
  • Give patients advance written notice when a lifetime limit may be reached.
  • For verification workflows, see eligibility and COB denials.

Remark codes that may appear with CO-149

  • N117 (This service is paid only once in a patient's lifetime.): The service is paid only once in a patient's lifetime.
  • N587 (Policy benefits have been exhausted.): Policy benefits have been exhausted.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Refers to the plan benefit documents that define the limit.
  • CO-35 (Lifetime benefit maximum has been reached.): Lifetime benefit maximum reached for the plan overall, rather than for one category.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): Benefit maximum for a time period reached, which resets.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage or program guidelines were exceeded.
  • CO-96 (Non-covered charge(s).): Non-covered charges in general.

CO-149 FAQ

How is CO-149 different from CO-35?

CARC 35 means the lifetime maximum for the plan as a whole has been reached. CARC 149 means the lifetime maximum for a specific service or category, such as a particular type of treatment, has been reached.

Are lifetime limits still allowed?

Federal law generally prohibits lifetime dollar limits on essential health benefits for most plans. Limits can still apply to services that are not essential health benefits, to some plan types, and as non-dollar limits. Check the plan.

Can I appeal CO-149?

Appeal if the payer counted services that should not count toward the limit, or if the limit may not be permitted for that plan and benefit. Include the plan documents and service history.