US · guidance
CMS Pub. 100-04, ch. 32, § 140.4.2.3
Daily Frequency Edits for PR Claims
Effective for claims with dates of service on or after January 1, 2010, Medicare contractors shall deny all PR
claims (both professional and institutional claims) that exceed two units on the same date of service.
The following messages shall be used when Medicare contractors deny PR claims for exceeding the daily
frequency limit:
CARC 119: “Benefit maximum for this time period or occurrence has been reached.”
RARC N362: “The number of days or units of service exceeds our acceptable maximum.”
MSN 20.5: “These services cannot be paid because your benefits are exhausted at this time.”
Spanish Version: “Estos servicios no pueden ser pagados porque sus beneficios se han agotado.”
Contractors shall use Group Code PR (Patient Responsibility) assigning financial liability to the beneficiary, if a
claim is received with a GA modifier indicating a signed ABN is on file.
Contractors shall use Group Code CO (Contractual Obligation) assigning financial liability to the provider, if a
claim is received with a GZ modifier indicating no signed ABN is on file.
History
(Rev. 1966, Issued: 05-07-10, Effective: 01-01-10, Implementation: 10-04-10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b904091867b69488d5f96d0067dc650bb9c7f002a0e789c7ad3f91bd2aee5d98
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