Denial Code CO-45: Description, Meaning and How to Fix It
The amount billed is higher than the payer's contracted (allowed) rate. The difference is a contractual write-off, not a patient balance.
Official description
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
Common cause
Standard on nearly every paid claim - it is the gap between your charge and the payer's fee schedule. It is only a problem if the allowed amount itself looks wrong (a possible underpayment).
How to fix it
Usually no action - post the contractual adjustment. If the allowed amount is below your contracted rate, it is an underpayment worth appealing against the fee schedule.
Related denial codes
- CO-16: The claim is missing required information or has an error. It is almost always paired with a RARC that names the specific missing field.
- CO-97: This service is bundled into another service that was already paid, so it is not paid separately.
- CO-18: The payer received this exact claim/service already.
- CO-22: Another insurer should be billed first under coordination of benefits.
- CO-29: The claim was submitted after the payer's filing deadline.
- CO-50: The payer decided the service was not medically necessary as billed.