835 Denial Combination
CO-45
Contractual Obligation · Service-Line Level Adjustment
Contractual AdjustmentWhat This Combination Means
The billed charge exceeds the fee schedule or contracted rate established in the provider's agreement with the payer. The difference between the billed amount and the allowable amount must be written off by the provider as a contractual obligation. This is a standard reimbursement adjustment, not a denial of service.
Financial Responsibility
provider writeoff
The provider is contractually obligated to write off the amount that exceeds the fee schedule or contracted rate. The patient cannot be billed for this adjustment amount.
N/A
Appeal Success
Immediate (write-off)
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-45 combination — not generic advice.
- 1
Verify the contractual allowable amount in your payer contract or fee schedule
Confirm the adjustment reflects the correct contracted rate for the service code and place of service billed
- 2
Post the contractual adjustment as a write-off in your practice management system
Apply the CO-45 amount to the appropriate service line as a non-billable adjustment
- 3
Review billing procedures to align future charges with contracted rates
Consider updating fee schedules in your billing system to reduce adjustment variance on future claims
Specialty Context
How CO-45 typically presents across different practice types.
Dental
Common for procedures where UCR charges exceed PPO or Medicaid fee schedules, particularly for crowns, implants, and surgical procedures.
Medical
Frequently appears on claims for all specialties when billed charges exceed contracted rates, especially for procedures, imaging, and evaluation and management services.
Behavioral Health
Appears when therapy or psychiatric service charges exceed contracted session rates or state Medicaid mental health fee schedules.
Individual Code References
View the standalone definition for each code in this combination.
Medicare Contractor Guidance for CARC 45
NoridianPayment 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
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