Charge exceeds fee schedule / contracted amount
The provider billed more than their contract with the insurer allows. You are not responsible for the difference on in-network care.
Fix goes to the provider's billing office
Cite the CO-45 adjustment. If the provider is in-network, the balance above the contracted amount is a contractual write-off and must not be balance-billed to the patient. Request written confirmation the balance has been removed.
- Request a fully itemized bill from the provider — not the summary statement.
- Match every line on the itemized bill to a line on your EOB. Charges that appear on one and not the other are the usual source of errors.
- Ask the insurer, in writing, for the specific plan provision behind the code.
- Note the appeal deadline printed on your EOB and diary it — missing it forfeits the appeal.
What does denial code CO-45 mean?
CO-45 means "Charge exceeds fee schedule / contracted amount". The provider billed more than their contract with the insurer allows. You are not responsible for the difference on in-network care.
Do I have to pay a CO-45 charge?
Usually not directly. CO-45 points to a provider-side billing or coding issue, so ask the billing office to correct or write off the charge before you pay anything.
How do I appeal a CO-45 denial?
Cite the CO-45 adjustment. If the provider is in-network, the balance above the contracted amount is a contractual write-off and must not be balance-billed to the patient. Request written confirmation the balance has been removed.
Where do I send a CO-45 appeal?
Fix goes to the provider's billing office. Use the appeals address printed on your EOB or the provider's statement, send it in writing, and keep a dated copy. If an internal appeal fails, most states also offer an independent external review.
How long do I have to appeal CO-45?
Most commercial plans allow 180 days from the date on the Explanation of Benefits for an internal appeal; Medicare and some employer plans differ. Check the appeal-rights section of your EOB and file early — missed deadlines are the most common reason appeals fail.
Let BillCheck write the CO-45 appeal for you
Upload your EOB and itemized bill. We decode every code, flag the errors, and draft a ready-to-send appeal letter addressed to the right office.
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BillCheck provides informational analysis only and is not legal, medical, or financial advice. Verify all details before submitting any correspondence to insurers or providers.