Denial code library

CO-45: Charge exceeds fee schedule

Triage: Contractual write off, not a denial

What CO-45 means

This is not a denial at all. It is the contractual difference between what you billed and what your contract with the payer allows. It appears on nearly every paid claim.

What it usually means in a chiropractic office

The danger is treating it like a balance. The CO-45 amount is never patient billable when you are in network. Billing patients for contractual adjustments is a contract violation and one of the fastest ways to generate complaints.

How to work it

  1. Post the payment, adjust the CO-45 amount off as contractual, and move on.
  2. Watch the pattern over time: if allowed amounts shrink, that is a fee schedule change worth confirming with the payer.

What this looks like in practice

You bill 98941 at $85 against a contract that allows $52. The ERA shows a CO-45 of $33 on the line beside the payment. Nothing went wrong; the number is your negotiated discount showing itself on every claim. The failure mode is a biller moving that $33 to the patient, which violates the contract.

How to stop it from happening again

How Cervica handles CO-45

ERA auto posting writes the contractual adjustment automatically and never moves a CO-45 amount to patient responsibility. The payment learning table tracks allowed amounts per code per payer so a quiet fee schedule change shows up as a variance.

Related codes

References

  1. X12, Claim Adjustment Reason Codes (the official CARC list)

General information for billing teams, not legal or payer specific advice. CARC definitions belong to X12; payer policies vary and control. Verify against the payer contract before acting on any individual claim.

See how the denial worklist works Start your 30 day free trial