CO-222: Units are over the contracted limit

The payer is telling you that you billed more days, hours, or units than your contract or the member's benefit allows. Anything over that limit is not payable under the agreement. Mechanically, a units or length-of-stay edit fires when the claim's units exceed the allowed maximum tied to the CPT/HCPCS, revenue code, or authorization. The payer pays only up to the limit and writes the extra off as a CO denial, which becomes provider liability unless you correct the billing or the auth.

In behavioral health, this hits a lot on per-diem levels of care like PHP, IOP, residential, and detox when treatment runs longer than the authorized or benefit-max days. For example, a PHP claim for 28 days gets paid for 20 days, and the extra 8 per-diem units hit CO-222 because the auth or plan capped PHP at 20 days. You also see it on hourly or unit-based services: group therapy (90853), individual therapy (90837), or testing codes when you bill more units than allowed per day, per episode, or per auth period. A common pattern is an IOP program billing 4 units per day when the authorization or contract only allows 3 units, so the fourth unit goes to CO-222. Medicaid and MCOs often hard-cap units for SUD IOP, OTP counseling, or telehealth visits. For example, a state Medicaid plan may only allow a set number of telehealth psychotherapy visits per month or a weekly cap on OTP counseling units. Once you cross that cap without an updated authorization, the excess units deny under CO-222 and you lose those days or hours in revenue.

• Confirm the member's benefit and the authorization to see the exact allowed days, hours, or units for the code and level of care.
• Compare the allowed amount to what was billed per line to identify which dates or units are over the limit.
• Check clinical records and scheduling to see if you truly rendered more units than were authorized or if units were miscounted or duplicated.
• If it is a billing error, correct the units or date span on a replacement or corrected claim so billed units match the contract or auth.
• If services were legitimately provided beyond the limit, request an auth extension or post-service review from the payer and submit an appeal with clinicals tied to the denied units.
• Document the payer's unit limits and the outcome of any extension or appeal so future claims for the same patient and program match the approved span.

• At intake and during concurrent review, verify benefit maximums and authorization limits for days, hours, and units by code and level of care.
• Configure your EHR or billing system to track used versus remaining units per authorization and to flag schedulers and clinicians when a patient is nearing the cap.
• Set claim-scrubber rules that block or warn on claims where billed units, HLOC days, or service frequency exceed the authorization or known benefit limits.
• Train utilization review, scheduling, and billing teams to coordinate on extensions before the last approved day so claims never exceed the authorized span.