CO-35
Lifetime benefit maximum has been reached
What This Code Means
The patient has used up the plan’s lifetime maximum benefit for this category of service.
Common Causes
- Patient has a history of high utilization in this benefit category
- Lifetime cap reached and not yet reflected in scheduling systems
How to Resolve or Appeal
- Confirm the lifetime maximum and usage history with the payer
- Check for secondary coverage that may pick up the balance
More Denial Codes to Check
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.