Who has to pay after a code 122 denial?

Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.

How long do I have to appeal?

It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.

All denial codes · code 122

Denial code 122: what it means — and how to fight it

Denial code 122 (shown on your EOB as CO-122 or PR-122) means: “Psychiatric reduction.” In plain English: The plan paid less than the full amount for mental health care under a special mental health rule.

high appealability Who owes depends on the details

What they're really saying

“Psychiatric reduction.”

The plan paid less than the full amount for mental health care under a special mental health rule.

Your odds

Strong — this type of denial has real weaknesses.

Parity challenges are among the stronger appeals when the plan treats mental health worse than medical care.

Fewer than 1 in 100 denied claims are ever appealed. When people do appeal, roughly 4 in 10 win the first round — and independent external review overturns 40–50% of what reaches it.

How to appeal a code 122 denial

Decode. You just did — this page is step one.
Set your clock. 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, only 65 for Medicare Advantage.
Urgent? If this is care you still need, call and request an expedited appeal — they must decide within 72 hours.
Ask the plan in writing why this reduction applies to mental health but not to comparable medical care. Federal parity law generally bars stricter limits on mental health benefits than on comparable medical benefits. Ask the plan in writing for its parity analysis: the specific limit applied, and the comparable medical/surgical limit. If they cannot show equivalence, escalate to your state insurance department or the Department of Labor for an employer plan.
Send it certified. Letter plus evidence, keep copies of everything.
Escalate. Denied again? Independent external review — a doctor who doesn't work for your insurer decides.

Do it in minutes, free

The AppealClock tool translates your denial, drafts your appeal letter, computes your exact deadline — and watches the clock so you don't have to. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

What does denial code 122 mean?: The plan paid less than the full amount for mental health care under a special mental health rule.
Can I appeal a CO-122 or PR-122 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are high: Parity challenges are among the stronger appeals when the plan treats mental health worse than medical care. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 122 denial?: Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.
How long do I have to appeal?: It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.