Skip to main content

CO-222 Denial Code: Provider Contract Maximum Exceeded

CO-222 means the provider exceeded the contracted maximum number of hours, days, or units for the period. The limit applies to the provider as a whole, not to an individual patient, so a service can be denied even when this patient's own limits were never reached.

Quick facts

Code
CO-222 (CARC 222)
Status
Active In use since June 1, 2008; last modified July 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The provider is responsible under the contract cap. The amount generally cannot be billed to the patient.
Official description
Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-222 means

CARC 222 says the service exceeds the contracted maximum number of hours, days, or units by this provider for this period. This is not patient specific. The limit is written into your agreement with the payer and applies to your total volume, for example a maximum number of service hours per month or treatment days per contract year.

Most limit denials look at one patient’s benefits or authorization. CO-222 is different: the patient’s own coverage can be fine, but the payer stops paying because the provider as a whole used up its allotment. Claims processed later in the period are more likely to hit it, so a patient’s claim may be denied simply because of timing.

Example: a contract allows a provider a set number of service hours per month for a program. Claims for the first part of the month pay normally; once total billed hours pass the cap, later claims in that month come back as CO-222.

Common causes

  • Volume caps in capitated, program-based, or public-funded contracts.
  • Program allocations for services like home and community-based care, where a provider is allotted a fixed number of units.
  • Multiple locations or clinicians billing under one contract without shared tracking.
  • Claims submitted out of order, so a later date of service used the allotment first.
  • Payer counting error, such as counting voided or duplicate claims toward the cap.

How to fix it

  1. Confirm the cap in your contract or through the policy reference in loop 2110 REF, if present.
  2. Reconcile your usage for the period against the payer’s count. Look for duplicates, voided claims, or claims from another period counted in error.
  3. If the payer miscounted, request reprocessing with your reconciliation.
  4. If the contract allows, ask about an increased allotment or an amendment for documented demand.
  5. If the cap was legitimately exceeded, post the adjustment. Do not bill the patient.

How to prevent it

  • Track units, hours, or days used against each contract cap in real time, not at month end.
  • Share one tracking source across all locations and clinicians that bill under the contract.
  • Alert schedulers as the cap approaches so they can plan or seek approval before exceeding it.
  • Submit claims promptly and in date order.
  • Renegotiate caps that no longer match your patient volume.

See MUE denials and units of service for the patient- and claim-level unit limits that are often confused with contract caps.

Remark codes that may appear with CO-222

  • N362 (The number of Days or Units of Service exceeds our acceptable maximum.): The days or units exceed the payer's acceptable maximum.
  • N381 (Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.): Points to the contract term that sets the provider-level cap.
  • N640 (Exceeds number/frequency approved/allowed within time period.): The number or frequency allowed within a time period was exceeded.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): A patient's benefit maximum was reached, which is patient-specific unlike 222.
  • CO-198 (Precertification/notification/authorization/pre-treatment exceeded.): The services exceeded the patient's authorization.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): The payer found the information did not support the number or frequency of services.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage or program guidelines were exceeded.

CO-222 FAQ

What does 'not patient specific' mean on CO-222?

It means the cap is on the provider's total services under the contract, such as total hours per month across all members. Any patient's claim can be the one that crosses the limit.

Can I bill the patient for CO-222?

No. The limit comes from your contract, so the CO group makes the excess the provider's responsibility.

Where do I find the contract cap?

The official usage points to the 835 Healthcare Policy Identification REF in loop 2110, if present. Otherwise, check your contract or ask your payer contracting contact.