OA-222: Exceeds Contracted Maximum Hours/Days/Units

What Does OA-222 Mean?

With OA (Other Adjustments), the contractual limit was applied during coordination of benefits. Review each payer's contract limits separately.

CARC 222 indicates that the service billed exceeds the contractual limit for hours, days, or units established between the provider and the payer. Unlike CARC 198 (which relates to authorization limits), this code specifically refers to contractual maximums — the ceiling defined in the provider agreement rather than a per-patient authorization.

This is common in home health, physical therapy, occupational therapy, and other services where contracts specify maximum units per day, visits per episode, or hours per treatment period. The excess services are denied because they fall outside the provider's contractual arrangement.

Common Causes

How to Resolve

1. Review each payer's limits Verify the contract maximum for each payer.
2. Appeal to the appropriate payer Submit medical necessity documentation to the payer with the exceeded limit.

How to Prevent OA-222

• Track contractual limits for each payer separately

General Prevention

• Monitor contracted maximums across all payer relationships
• Coordinate with payers on maximum status

Also Filed As

The same CARC 222 may appear with different Group Codes:

Related Denial Codes