How do I resolve a CO-45 denial?

Payment may be recouped if it is established that the patient concurrently receives treatment under an HHA episode of care because of the consolidated billing requirements See full Medicare contractor resolution steps at tryarceum.com.

Can I appeal a CO-45 denial?

CO-45 denials are generally not appealable. Contractual adjustments based on agreed-upon fee schedules or legislated rates are generally not appealable as they reflect binding contract terms.

CARC Code

45

🟡 Soft Denial

Charge Exceeds Fee Schedule or Contract

The amount billed is higher than what the insurance plan allows for that service based on their fee schedule or your contract with them. The excess amount is being written off as a contractual adjustment.

contractual

Resolution: 99%Easy difficulty1 days avg

How to resolve this denial

Which payer denied this claim?

▶✓ Pre-action checklist — verify before contacting the payer

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-45 — stats, related codes, appeal template

99%

Recovery Rate

1 days

Avg. Resolution

Easy

Difficulty

Very Common

Frequency

Payer-Specific Notes

How major payers handle CARC 45 by specialty.

Medicare

Medicare Fee Schedule applies; adjust to allowed amount; limiting charge applies to non-par providers

Medicaid

Medicaid fee schedule often lowest; contractual adjustment may be significant

Common 835 Combinations

CARC 45 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-45The billed charge exceeds the fee schedule or contracted rate established in COCO-45+N435This combination indicates the payer reduced the charge because the service was COCO-45+N1Note: An informational alert accompanies this denial. The payer reduced your COCO-45+MA18Note: An informational alert accompanies this denial. The primary payer has COCO-45+N607The payer has reduced the charge to zero or to a contracted rate because the COCO-45+N130The billed charge exceeds the contracted or fee schedule amount for this COCO-45+N362The payer reduced the reimbursement because the billed units or days of service COCO-45+N88Payment was made for this claim conditionally because an HHA episode of care

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 45 denials.

We are requesting a review of the fee schedule application for claim [CLAIM_NUMBER]. Our contracted rate for CPT [CODE] is $[CONTRACT_RATE] per our agreement dated [CONTRACT_DATE]. The allowed amount of $[ALLOWED] appears to reflect a non-contracted rate. Please reprocess at the contracted rate.

Generate a personalized appeal letter →

Need to resolve this denial?

Get a step-by-step resolution plan with payer-specific guidance and appeal letter generation.

Resolve this denial →

Was this helpful?

← Back to Code Library Automate denial follow-up →