CO-45 | Charge exceeds fee schedule

Industry

Healthcare

Canonical

/insurance/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.

Learn More

Use these links to pivot between the directory, a focused guide, and nearby related codes.

Hub

Guides

The Complete Insurance Claim Denial Codes Directory (2026 Edition)

Related Codes

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