CARC 45
Above the contracted rate
Not a denial. The billed charge exceeded the fee schedule, and the difference is a contractual adjustment.
Why you actually get this
- Standard contractual write-down against your negotiated rate.
- The payer applied a rate lower than your contract specifies.
- Your fee schedule has not been updated against the current contract.
How to check whether it’s correct
- 01Compare the allowed amount against your contracted rate line by line.
- 02Check whether the payer is applying the correct fee schedule for the date of service.
Sometimes worth appealing
This is where underpayments hide. The claim paid, so no denial report flags it, but the rate may be below contract. Reconciling allowed amounts against the fee schedule is tedious and most practices never do it — which is exactly why it recurs every month until someone notices.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.