CO-45 denial: Above fee schedule
The billed charge was higher than the payer's allowed amount, so the difference is written off as a contractual adjustment. This is usually a routine adjustment on a paid claim, not a true denial.
Common causes
- Your billed charge is above the payer's fee schedule or contract rate
- The payer paid the allowed amount, which is normal for an in-network claim
- A rare cause: the fee schedule or contract rate on file is out of date
How to fix it
- For most claims, post the adjustment as a contractual write-off and move on
- Compare the allowed amount to your contract; if it is lower than agreed, treat it as an underpayment and dispute it
- Do not bill the patient for the CO-45 amount when you are in network
How to prevent it
- Keep contract rates loaded in your billing system
- Review payments against expected amounts so underpayments surface early
Zenith billers and AR specialists work denials like this inside your practice-management system, and your practice stays the billing provider. See AR follow-up and medical billing.
Educational summary, not billing or legal advice. Payer rules and deadlines vary; always check the payer’s own policy and the remark code on your remittance.