CO-222 denial code: exceeds the contracted maximum units

CO-222 fires when the number of units, hours or services billed exceeds a maximum set in the provider's contract for a defined period. It is a contractual limit, and the document that governs it is the participating agreement rather than a medical policy.

What CO-222 means

Contracted maximums appear in agreements for therapy, behavioural health, home care and other services delivered in quantity, and they are frequently overlooked because they live in a fee schedule appendix rather than in the clinical policy a biller would consult. When this code fires repeatedly, the answer is usually contractual — a renegotiation or an exception process — rather than a series of individual appeals.

Why CO-222 fires

• Units billed exceed the per-day, per-visit or per-period maximum in the contract.
• Multiple providers in the group billed against a shared maximum.
• The contract's maximum changed at renewal and the practice was working from the prior schedule.
• Units were billed in a different measure than the contract defines.

Is CO-222 worth appealing?

How to resolve or appeal CO-222

1. 1

   Locate the maximum in the agreement

   Usually in a fee schedule appendix rather than the body of the contract.

2. 2

   Check the unit definition

   Contracts and code sets do not always measure units the same way, and a mismatch produces this denial without any excess care.

3. 3

   Escalate contractually if it recurs

   A limit that no longer fits the practice's case mix is a contract conversation, not an appeals one.

CO-222 — frequently asked

Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.