Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-45 | Charge exceeds fee schedule
Industry
Healthcare
Canonical
/healthcare/error-codes/co-45/
Last Updated
Feb 25, 2026
Summary
This code indicates that the billed charge exceeds the amount allowed under the payer’s fee schedule or contract.
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What This Code Means
CO-45 reflects a contractual adjustment where the provider’s billed amount is higher than the payer’s allowed amount. The insurer reduces the payment to align with the negotiated fee schedule. This is a common contractual adjustment and does not represent a denial of the service itself. It also does not indicate that the service was unnecessary or incorrectly coded. The adjustment is based on pre-established reimbursement rates.
Where Users Usually See This Code
- Provider remittance advice
- Patient EOB summaries
- Contractual adjustment reports
Why This Code Appears
- The billed charge exceeds contracted rates
- The payer applies standard fee schedule limits
- Network agreement pricing adjustments apply
What Typically Happens Next
- Payment is issued at the allowed amount
- The adjusted portion is written off per contract
- No further claim action is required
What This Code Is Not
- It is not a denial of coverage
- It is not a billing error
- It is not patient responsibility
Troubleshooting Checklist
- □ Review payer contract terms
- □ Confirm network participation status
- □ Reconcile adjustments in accounting records
Notes And Edge Cases
Out-of-network claims may show different adjustment behavior. Fee schedules can vary by region and payer. Some plans apply multiple adjustments on a single line item.
Related Codes
8 links
- CO-42 CodeCharges exceed provider’s contract
- CO-151 CodePayment adjusted due to contractual agreement
- CO-200 CodeNon-covered service
- CO-11 CodeDiagnosis inconsistent with procedure
- CO-54 CodeMultiple physicians not allowed
- CO-96 CodeNon-covered charge(s)
- CO-39 CodeServices denied as experimental
- CO-61 CodeProcedure not covered for age
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