CO-45 Denial Code Explained

CO-45 is a medical billing denial code that indicates the billed charge exceeds the payer’s maximum allowable amount or contracted fee schedule. This adjustment is commonly applied when the provider charges more than the amount approved by the insurance payer.

What Does CO-45 Mean?

The CO-45 denial code means the insurance payer adjusted the claim because the billed amount is higher than the allowed reimbursement amount under the patient’s insurance plan or provider contract.

This denial is often related to contractual adjustments between providers and insurance payers.

Common Reasons for CO-45

• Charges exceed contracted payer rates

• Incorrect fee schedule billing

• Outdated billing amounts

• Non-covered charge amounts

• Duplicate charge adjustments

• Contractual payment limitations

How To Fix CO-45

Review the payer’s explanation of benefits (EOB) and compare the billed amount to the contracted reimbursement rate. Verify that the claim was billed correctly and confirm whether the adjustment is contractual or requires correction.

In many cases, CO-45 is considered a standard contractual adjustment and may not require resubmission.

Quick Summary

CO-45 indicates the billed amount exceeded the payer’s allowable reimbursement rate. Most CO-45 adjustments are related to provider contracts and fee schedule limitations rather than claim submission errors.