CO-149 denial code
Lifetime benefit maximum has been reached for this service category
How to fix it
Confirm the maximum and category, then check for secondary coverage.
How to prevent it
Track category maxima for patients receiving capped services over long courses of care.
In practice
A patient receiving long-term physical therapy after a spinal injury reaches the plan's lifetime maximum for rehabilitation services. The claim returns CO-149.
Unlike a general lifetime cap, this one applies to a specific benefit category. Other services under the same plan remain fully available; only rehabilitation has run out.
Verify the accumulator was applied to the right category, because misallocation is common where a service could plausibly sit in more than one. Then look for secondary coverage or a separate benefit that describes the same care differently.
What sits behind it
Category boundaries are where appeals find room. A service billed as rehabilitation might equally qualify as habilitative, or as part of a covered post-surgical benefit, and plans do not always allocate correctly. Establishing that the accumulator drew from the wrong category can restore the benefit entirely.
The lawfulness question also applies here. Lifetime dollar limits on essential health benefits are prohibited on compliant plans, and rehabilitative and habilitative services are within the essential benefit categories, which makes a dollar cap on them worth challenging directly.
Where the cap is expressed in visits rather than dollars it generally survives, but visit limits attract their own scrutiny under mental health parity rules when applied to behavioural health. A plan capping behavioural visits more tightly than comparable medical ones is a parity question, not merely a benefit design.
Related codes
Terms used here — Patient Responsibility · Appeal · Eligibility Verification
How we handle it — Eligibility Verification · Denial Management · Patient Support
Primary sources
The rules behind CO-149, at the bodies that publish them.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
- Medicare Benefit Policy Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — What Medicare covers and under what conditions, as distinct from how a claim is processed. The starting point for any coverage or medical necessity question.
- Advance Beneficiary Notice of Noncoverage (ABN) (opens in a new tab)
Centers for Medicare & Medicaid Services — The form and the rules for issuing it. Whether a non-covered service can be billed to the patient usually turns on whether a valid ABN was obtained beforehand.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-149
Sometimes on two grounds. Dollar limits on essential health benefits, which include rehabilitative and habilitative services, are prohibited on compliant plans. And the accumulator may have drawn from the wrong category, which restores the benefit if you can show the misallocation.
CO-35 reports a general lifetime maximum across the plan. CO-149 reports one confined to a specific benefit category, meaning other services remain available. That distinction matters because the misallocation argument only exists where categories are separated.
They are treated differently and generally survive where dollar limits would not. Behavioural health visit limits carry an additional question under mental health parity rules, since a plan capping those more tightly than comparable medical services may not be applying the benefit lawfully.
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