What does denial code CO-35 mean?

Lifetime benefit maximum reached. The patient has used the plan's lifetime maximum for this benefit.

How do I fix a CO-35 denial?

Check for secondary coverage. Discuss patient responsibility, with notice where required.

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Claim adjustment reason code · Contractual obligation

CO-35
Lifetime benefit maximum reached

What CO-35 means

The patient has used the plan's lifetime maximum for this benefit.

The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.

Common causes

Benefit exhausted

How to fix it

Check for secondary coverage
Discuss patient responsibility, with notice where required

Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.

Prevent it next time

Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.

Other codes

All denial codes →

Let us work your denials.

We triage every denial by code and payer, fix or appeal it, and stop it repeating.

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CO-35Lifetime benefit maximum reached