CARC Code
149
Lifetime Benefit Maximum Reached
The patient's insurance plan has a cap on how much it will pay for certain services over their entire lifetime, and that limit has been met. No further benefits are available under this plan for this type of service.
contractualHow to resolve this denial
Accept lifetime reserve day adjustment; bill patient coinsurance for reserve days
- 1
Verify patient's cost-share obligation on the Explanation of Benefits
- 2
Cross-reference with the patient's Summary of Benefits and Coverage
- 3
Calculate the correct patient responsibility amount
- 4
Issue a patient statement within 30 days of claim adjudication
- 5
Document the patient balance in the account notes
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about CO-149 — stats, related codes, appeal template
99%
Recovery Rate
1-3 days
Avg. Resolution
Easy
Difficulty
Rare
Frequency
Payer-Specific Notes
How major payers handle CARC 149 by specialty.
UnitedHealthcare
Review UHC's online claim status tool for additional detail on this adjustment.
Common 835 Combinations
CARC 149 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 149 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 149 indicating: "Lifetime reserve days — inpatient claim.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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