What does CARC 222 mean?

CARC 222 means "Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. DNFBs are included.". The recommended action is: Review contracted limits; appeal with updated care plan documentation if limit was incorrectly applied.

How do I resolve CARC 222?

Pull the original claim and review the denial reason and any RARC codes Research the payer's policy for CARC 222 to understand the basis for denial Gather supporting documentation addressing the denial reason Submit a formal appeal with the documentation within the plan's appeal window Follow up on the appeal within 30 days and document all communication

Can CARC 222 be appealed?

CARC 222 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

222

🔴 Hard Denial

Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. DNFBs are included.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Recommended Action

Review contracted limits; appeal with updated care plan documentation if limit was incorrectly applied

Step-by-Step Resolution

1
Pull the original claim and review the denial reason and any RARC codes
2
Research the payer's policy for CARC 222 to understand the basis for denial
3
Gather supporting documentation addressing the denial reason
4
Submit a formal appeal with the documentation within the plan's appeal window
5
Follow up on the appeal within 30 days and document all communication

Payer-Specific Notes

How major payers handle CARC 222 in practice.

MetLife Dental

MetLife provides detailed denial reason codes — check EOB for supplemental information.

Appeal Letter Template

Enter your email to access the full appeal template for CARC 222.

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 222 indicating: "Exceeds contracted maximum number of hours/days/units by this code and modifier ." 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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