CARC Code
45
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
99%
Recovery Rate
1 days
Avg. Resolution
Easy
Difficulty
Very Common
Frequency
Recommended Action
Accept contractual adjustment; do not bill patient for the difference
Step-by-Step Resolution
- 1
Verify the payer's allowed amount against your fee schedule or contract
- 2
Calculate the contractual adjustment (billed amount minus allowed amount)
- 3
Post the contractual adjustment in your billing system as a write-off
- 4
Do not bill the patient for the contractual difference — this is a prohibited balance bill
- 5
If the allowed amount seems incorrect, request a fee schedule review from the payer
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 45 on remittance advice.
→ Cap patient billing at EOB limiting charge amount
Payer-Specific Notes
How major payers handle CARC 45 in practice.
Delta Dental
UCR (Usual, Customary & Reasonable) fees may be below your billed rate; accept adjustment per contract
MetLife Dental
Table of Allowances plans use fixed allowed amounts regardless of billed charges
Common 835 Combinations
CARC 45 most often appears with these Group Code + RARC combinations on 835 remittances.
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