CARC 222: Exceeds the contracted maximum number of hours/days/units by this provider for this period.
Exceeds the contracted maximum number of hours/days/units by this provider for this period.
CARC 222 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 222 means
The official X12 description is: “Exceeds the contracted maximum number of hours/days/units by this provider for this period.”
In plain language: Exceeds the contracted maximum number of hours/days/units by this provider for this period.
What to do next 222
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
DenialHelp helps organize a source-linked draft from the denial notice and confirmed case facts. The patient and treating clinician must verify the governing review rule, current payer policy, clinical sources, attachments, destination, and deadline.
CARC 222 group codes explained
On the 835 ERA, CARC 222 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 222 mean?
Exceeds the contracted maximum number of hours/days/units by this provider for this period. In plain language: Exceeds the contracted maximum number of hours/days/units by this provider for this period.
Is CARC 222 appealable?
Yes — CARC 222 is one of the codes that commonly supports an appeal. Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Which group code does CARC 222 appear under?
CARC 222 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
How do I appeal a CARC 222 denial?
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Related resources
Sources
Appeal a CARC 222 denial
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