CARC Code
119
Benefit maximum for this time period or occurrence has been reached.
20%
Recovery Rate
5-10 days
Avg. Resolution
Medium
Difficulty
Occasional
Frequency
Recommended Action
Inform patient of benefit exhaustion and bill patient for remaining services
Step-by-Step Resolution
- 1
Verify the benefit maximum type: dollar maximum, visit limit, or occurrence limit
- 2
Check the patient's year-to-date accumulation against the plan maximum
- 3
Confirm whether the patient has a secondary insurance that may cover remaining services
- 4
Notify the patient immediately that their benefit maximum has been reached
- 5
Obtain signed financial responsibility form before continuing treatment
- 6
Explore alternative coverage options: dental savings plans, financing, secondary insurance
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 119 on remittance advice.
→ Review plan benefit documents for maximum accumulation rules
Payer-Specific Notes
How major payers handle CARC 119 in practice.
Delta Dental
Annual maximum typically $1,000-$2,000; resets January 1; verify plan year vs. calendar year
MetLife Dental
Lifetime ortho benefit maximum separate from annual maximum; track separately
Common 835 Combinations
CARC 119 most often appears with these Group Code + RARC combinations on 835 remittances.
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