CO-35: lifetime benefit maximum reached.

What X12 says CARC 35 means

Lifetime benefit maximum has been reached.

CARC 35 · Start 01/01/1995, last modified 10/31/2002.

In plain terms: The lifetime benefit maximum has been reached.

What it means on a remittance

The payer says the patient has used up a plan limit that applies over the patient’s whole time on the plan, not one year. CARC 119 is the related code for a benefit maximum for a time period or occurrence.

Typical causes

• The plan has a dollar or visit limit for a benefit and the patient’s claims have reached it.
• The payer’s accumulator counted claims that were reprocessed or belong to a different benefit.
• The service falls in a category with a lifetime limit, such as a particular type of therapy or equipment under the plan.
• The patient has another plan that should be billed.

These are common billing patterns, not a diagnosis of your claim. The remittance and the payer's policy decide.

What to check

1. Ask the payer which benefit limit applies and the amount used to date.
2. Check the plan documents for the limit and the benefit category.
3. Ask whether another payer is primary or secondary.
4. Check your own records against the payer’s count of used benefits.

Correct, resubmit or appeal

If the limit is right, bill any other coverage or follow your policy for patient accounts. If the payer’s count is wrong, ask for an accumulator review with your records and use its appeal process.

Medicare dates that apply

A Medicare redetermination request must be filed within 120 calendar days from the date a party receives the notice of the initial determination; receipt is presumed 5 calendar days after the notice date unless there is evidence to the contrary (42 CFR 405.942(a)), and a late request can be considered for good cause (405.942(b)). Other payers set their own appeal windows in the contract or plan documents, so read the notice for the date. The tool above runs the date math.

Related codes

X12 does not publish a table that pairs each code with remark codes; the payer picks the remark code and prints it beside the CARC on the same remittance line.

Other codes: CARC 119 (benefit maximum for a period), CARC 22 (another payer may cover) and the full lookup.

Worked example (hypothetical)

A claim for a covered therapy denies with CO-35. The payer says the plan’s limit for that benefit is used up. The biller asks the patient about other coverage and finds a secondary plan.

Sources

• X12: Claim Adjustment Reason Codes — code text, usage notes and dates (list dated 10/30/2026, retrieved 2026-11-02)
• 42 CFR 405.942 — eCFR, current through 2026-10-29 (retrieved 2026-11-02)

Code descriptions are X12 copyrighted material, quoted here only for the codes on this page and linked to the owner. For the full lists, use X12. The X12 text and the Medicare rule above were read from these pages on November 2, 2026. Causes, checks and examples are general billing practice written for this page, not X12 content. Payers revise code lists, contracts and policies, so confirm anything that affects a claim or a deadline with the payer.