CO-149Contractual Adjustment
Lifetime benefit maximum reached
What this code means
You have reached the maximum benefit your plan will pay over your lifetime for this type of service. Most lifetime limits were eliminated by the ACA for essential health benefits.
What to do next
Review your plan documents. If the denied service is an essential health benefit under the ACA, a lifetime limit should not apply. Appeal citing 45 CFR 147.126 which prohibits lifetime limits on essential health benefits.
Appeal outlook: High for ACA-covered essential health benefits
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