835 Denial Combination

CO-45+N362

CO

Contractual Obligation · Claim + Service Level Adjustment

Contractual Obligation

What This Combination Means

The payer reduced the reimbursement because the billed units or days of service exceeded the contracted or fee schedule maximum allowed for this service. The adjustment is a contractual write-off applied specifically to the excess units beyond the payer's acceptable threshold. This is a fee schedule or contract-based limitation on quantity, not a denial of medical necessity.

Financial Responsibility

provider writeoff

The provider must write off the reduced amount as a contractual adjustment per the payer agreement. The patient cannot be billed for the difference between the submitted charge and the allowed amount based on the unit limitation.

N/A

Appeal Success

Immediate (write-off)

Avg. Resolution

Easy

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-45+N362 combination — not generic advice.

Not Appealable:This is a contractual fee schedule adjustment based on pre-established unit limitations that the provider agreed to in the contract.
  1. 1

    Verify the contractual unit limitation for the specific service code

    Check the provider contract or fee schedule to confirm the maximum allowable units/days per claim or per service period for this procedure code

  2. 2

    Compare billed units against the payer's documented maximum

    Confirm that the adjustment corresponds to units billed in excess of the contractual threshold specified in N362

  3. 3

    Post the contractual adjustment as a provider write-off

    Apply the CO-45 adjustment to the patient account without transferring any balance to patient responsibility, as this reflects agreed-upon contract terms for unit maximums

Specialty Context

How CO-45+N362 typically presents across different practice types.

Dental

Common for preventive services with annual limits (e.g., prophylaxis limited to 2 per year) or restorative procedures with quantity restrictions per service period

Medical

Frequently seen with therapy services (PT/OT/ST) that have per-visit or per-week unit caps, DME with quantity limits, and infusion services with maximum units per billing period

Behavioral Health

Typical for outpatient therapy sessions subject to weekly or monthly visit limits, intensive outpatient programs (IOP) with daily unit maximums, or group therapy with per-session unit caps

Individual Code References

View the standalone definition for each code in this combination.

CARC 45RARC N362

Medicare Contractor Guidance for CARC 45

Noridian

Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient.

How to Prevent CARC 45 Denials

  • ✓

    Ensure eligibility is verified in the Noridian Medicare Portal for Home Health Episode History (HHEH)

  • ✓

    Utilize the Consolidated Billing Tool on the Noridian Medicare website to inquire on items covered in a HHA episode of care, prior to providing

Noridian Medicare PortalConsolidated Billing ToolFee Schedule

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Synthesized from official definitions — not from training data

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