CO-45: Charge Exceeds Fee Schedule / Maximum Allowable Amount
Charge exceeds fee schedule / maximum allowable amount (Contractual Adjustment)
1. What Does Denial Code CO-45 Mean?
Contractual adjustment code. The difference between the provider's gross billed charge and the contracted payer fee schedule. Under in-network provider contracts, this balance must be written off and cannot be balance-billed to the patient.
2. Top Root Causes for CO-45
Most CO-45 rejections trace back to one of the following billing or clinical discrepancies:
3. Resolution Checklist for CO-45
Interactive ChecklistStep through these concrete audit items before submitting a corrected claim or filing a formal appeal:
4. Appeal Strategy & Letter Template
Only appeal CO-45 if the paid amount is lower than the agreed-upon contracted rate in your fee schedule agreement. Otherwise, this is a standard contractual write-off.
RE: Contractual Fee Schedule Underpayment Dispute Payer: [Payer] | Claim ID: [Claim ID] | Contract ID: [Contract ID] We are disputing the allowed amount for CPT [CPT Code]. Under Section [Section] of our participating agreement, the contracted rate for this service is $[Agreed Rate], whereas your remittance applied an allowable of $[Paid Rate]. We request retroactive payment of the difference ($[Difference]).
Rather than reacting to CO-45 on post-adjudication 835 ERAs weeks after service, ClaimCure's pre-submission 4-bucket scrubber audits claims in real-time before electronic dispatch:
- Audit annual fee schedule changes from payers against contracted reimbursement matrices
- Ensure payment posting software verifies fee schedules automatically upon 835 ERA ingestion
Get the CO-45 Resolution Kit
Download our customized appeal checklist, CMS citation references, and payer timely filing matrix for CO-45.
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