CO-45: Charges Exceed Fee Schedule
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. The billed amount is higher than what the payer allows for this service.
Why Claims Get Denied with CO-45
Denial code CO-45 is triggered when charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. the billed amount is higher than what the payer allows for this service. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Billed charges exceed the payer's contracted rate or fee schedule
Medicare fee schedule amount is lower than billed charges
Out-of-network rate applied instead of contracted rate
Incorrect fee schedule applied by the payer
How to Appeal CO-45
This is typically an adjustment rather than a true denial — the payer is paying their allowed amount, not denying the service. Review your contract to confirm the correct fee schedule is being applied. If the allowed amount appears incorrect, request a review with your contract's fee schedule attached. For Medicare, verify the correct locality and facility/non-facility rate.
Documentation Required for Appeal
A successful appeal of CO-45 requires thorough documentation. Gather these items before drafting your appeal letter:
Copy of payer contract showing agreed rates
Medicare fee schedule lookup for the service and locality
Documentation of incorrect fee schedule application
How to Prevent CO-45 Denials
Maintain awareness of contracted rates for common procedures. Bill your standard charges (not the fee schedule amount) and let the payer adjust. Review EOBs to verify correct fee schedule application.
Stop Fighting CO-45 Denials Manually
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