CO 45: Charge Exceeds Fee Schedule
Charge is above the contracted rate. The difference is written off.
Contractual adjustment. Only worth review if the fee schedule loaded wrong.
See a finished review first
- No patient data
- No BAA
- No charge
- No pitch
What CO 45 means
CO: Contractual obligation. The provider absorbs it and cannot bill the patient.
So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
Is It Worth Appealing?
Not a denial. A contracted write-down or patient responsibility. Not money you lost.
Why It Fires
In the order we see it.
The charge exceeds the contracted rate. This is the write-down you agreed to.
What to Do With CO 45, Step by Step
Contractual adjustment. Only worth review if the fee schedule loaded wrong.
- 1Step 1: Read the remark code. Find the remark code printed next to CO 45 on the 835 or EOB. It says what the payer wants back. The usual ones are N381.
- 2Step 2: Find the cause. Match the denial to one of the cause in Why It Fires above, and fix that one.
- 3Step 3: Do this. Contractual adjustment. Only worth review if the fee schedule loaded wrong.
- 4Step 4: Attach the documentation. Your contracted fee schedule, if the allowed amount looks wrong for the code.
The common mistake. Do not appeal a correct contractual adjustment. Do check that the fee schedule loaded correctly, because a bad load shows up here first.
Free: the Denial Code Appeal Playbook. 53 codes on one sheet: appeal, fix and resubmit, or let it go, and what to attach. Get the playbook
CO 45 description
Charge is above the contracted rate. The difference is written off.
Charge is above the contracted rate. The difference is written off. So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
This is our plain-English wording, not the official X12 text. X12 asserts copyright over the published descriptions, so we write our own and say what it means for the money rather than restating the code.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
The Remark Code Beside It
The adjustment code says the claim was reduced. The remark code printed next to it says why, and it is the one that tells you what to send back.
| Remark | What it means |
|---|---|
| N381 | The payer is pointing at your contract rather than naming the rule it applied. |
Related Codes
Your Questions Answered
What does CO 45 mean?
Charge is above the contracted rate. The difference is written off. Contractual obligation. The provider absorbs it and cannot bill the patient.
Can you appeal CO 45?
Not a denial. Contractual adjustment. Only worth review if the fee schedule loaded wrong.
Why does CO 45 happen?
The charge exceeds the contracted rate. This is the write-down you agreed to.
What documentation wins a CO 45 appeal?
Your contracted fee schedule, if the allowed amount looks wrong for the code.
What do I do with CO 45?
Step 1: Read the remark code. Find the remark code printed next to CO 45 on the 835 or EOB. It says what the payer wants back. Step 2: Find the cause. Match the denial to one cause: The charge exceeds the contracted rate. This is the write-down you agreed to. Step 3: Do this. Contractual adjustment. Only worth review if the fee schedule loaded wrong. Step 4: Attach the documentation. Your contracted fee schedule, if the allowed amount looks wrong for the code.
Most searched: CO 97 · CO 96 · OA 23 · PR 204 · CO 109 · CO 197 · CO 50
How Much of This Is Sitting in Your Write-Off Pile?
No patient data. No BAA. No charge.
Upload your denial summary for the last 90 days. 4 columns: payer, CARC code, count, billed amount. You get back which were winnable and what they were worth.