PR-119 Denial Code Explained

PR-119 is a medical billing denial code that indicates the patient's benefit maximum for the current coverage period has been reached. This denial commonly occurs when a patient has exhausted the available benefits under their insurance plan.

What Does PR-119 Mean?

The PR-119 denial code means the patient's insurance benefits have reached the maximum amount allowed under the plan.

This denial is often related to annual benefit limits, service-specific maximums, or coverage restrictions.

Common Reasons for PR-119

• Annual benefit maximum reached

• Service-specific benefit limit exhausted

• Therapy visit maximum reached

• Dental or vision benefit limit reached

• Plan coverage cap exceeded

• Benefit period limitations

How To Fix PR-119

Review the patient's explanation of benefits and verify the remaining coverage available under the plan. Confirm whether the benefit maximum has been reached and determine if the balance may be assigned to patient responsibility.

If the denial appears incorrect, contact the payer and request a review of the patient's benefit usage and coverage limits.

Frequently Asked Questions

Can PR-119 be appealed?

In some cases. If the benefit maximum was calculated incorrectly, providers may request a review from the payer.

Can the patient be billed for PR-119?

Often yes. If the patient's benefits have been exhausted, the remaining balance may become the patient's responsibility.

What types of services commonly receive PR-119 denials?

Therapy services, dental services, vision care, and other benefits with annual maximums frequently receive PR-119 denials.

How can providers prevent PR-119 denials?

Verify remaining benefits and coverage limits before services are rendered.

Related Denial Codes

You may also encounter:

• PR-1 — Deductible amount

• PR-2 — Coinsurance amount

• PR-3 — Copayment amount

• CO-96 — Non-covered charge

Quick Summary

PR-119 indicates the patient's benefit maximum has been reached for the current coverage period. Most denials are caused by exhausted benefits, annual coverage limits, or service-specific maximums.