Who has to pay after a code 222 denial?

Usually the provider's problem — not yours. 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 222

Denial code 222: what it means — and how to fight it

Denial code 222 (shown on your EOB as CO-222 or PR-222) means: “Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.” In plain English: The provider hit a cap in their contract with the plan for this period. It's between them and the plan — usually not your bill.

low appealability Usually the provider's problem — not yours

What they're really saying

“Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.”

The provider hit a cap in their contract with the plan for this period. It's between them and the plan — usually not your bill.

Your odds

Check the math first — this is usually cost-sharing, not a judgment.

Not patient-specific; the provider resolves it with the plan.

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 222 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.
Confirm you weren't billed for the provider's contract cap. This is a provider-contract limit, not a coverage decision about your care. Confirm you are not being balance-billed for it under an in-network agreement.
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 222 mean?: The provider hit a cap in their contract with the plan for this period. It's between them and the plan — usually not your bill.
Can I appeal a CO-222 or PR-222 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are low: Not patient-specific; the provider resolves it with the plan. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 222 denial?: Usually the provider's problem — not yours. 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.