What is the EOB code 45?

Asked by: Garrett Weissnat Sr.  |  Last update: September 20, 2025
Score: 4.6/5 (38 votes)

45 = $xx. xx; a common informational code letting providers know that their charges exceed the fee schedule maximum allowable by the amount indicated. You would find this code on paid lines on a claim.

What is the reason code 45 on EOB?

Denial code 45 is used when the charge for a service exceeds the fee schedule, maximum allowable amount, or the contracted/legislated fee arrangement. This means that the amount being charged for the service is higher than what is allowed or agreed upon by the payer.

What does code 45 mean in a hospital?

Healthcare providers face a CO 45 error when their billed amount exceeds the agreed-upon charges. The CO 45 is one of the most common medical claim denial codes and is a component of the Claim Adjustment Reason Code (CARC). It simply highlights the reasons for claim denial or reduced payment.

What does condition code 45 mean?

Patients. Summary: Use modifier KX (requirements specified in the medical policy have been met) and Condition Code 45 (Ambiguous Gender Category) on claims for services for transgender, ambiguous gender, or hermaphrodite patients.

What is occurrence code 45?

45 Date treatment started for speech therapy - Code indicates the date services were initiated by the billing provider for speech therapy.

What is Denial Code CO 45?

26 related questions found

What is event code 45?

(Code 45)” This error occurs if a device that was previously connected to the computer is no longer connected. To resolve this problem, reconnect this hardware device to the computer.

What is value code 45?

Value codes Accident hour–For inpatient claims, if the patient was admitted as the result of an accident, enter value code 45 with the time of the accident using military time (00 to 23).

How to resolve denial code 45?

You can appeal if you receive a CO-45 denial code and believe it was unjustified or incorrect. You should first review the claim status and check if the payment went toward the patient's deductible or coinsurance. If not, you can submit an appeal request with supporting documentation to the insurance company.

What is error codes 45 on carrier?

The 45 code CAN mean board problem but likely it's a problem in the flame sense circuit whereby humidity or dirt is faking the control out as if it senses a flame. The first step would be to reset the control by cycling the power. If the 45 comes back you can disconnect the flame sensor and try again.

What is a pr45 in medical billing?

This denial code is also able to be part of group code PR (Patient Responsibility), depending on the liability. PR-45 comes into play when there is some patient responsibility within the adjustment. To put it more simply, it usually involves deductibles and copays.

What is code 45 in hospital?

In conclusion, the CO-45 denial code is one of the most common denial codes used in medical billing. It occurs when the physical billed amount exceeds the allowed amount, usually due to a contractual obligation between the healthcare provider and the insurance company or other payer.

What is the insurance code 45?

Denial code CO 45 is one of the most common denial codes insurance companies use. It is “Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.” In simpler terms, it means that the provider has charged more than what is allowed or agreed upon by the insurance company.

What is the most serious code in hospital?

"Code blue” is used to indicate that a patient requires resuscitation or is in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of "Code blue, [floor], [room]" to alert the resuscitation team where to respond.

What are EOB codes?

An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice.

How to read an EOB for dummies?

The explanation of benefits lists the cost of your care, and how much your health insurance company will pay.
  1. “Provider Charges” is the amount your provider bills for your visit.
  2. “Allowed Charges” is the amount your provider will be paid. ...
  3. “Paid by Insurer” is the amount your health plan will pay to your provider.

What is a PI 45 denial code?

PI-45 Code – Service Not Covered

This code signifies a service that isn't covered under the patient's current plan. Adonis Intelligence's eligibility checks help in pre-determining service coverage and alerting providers beforehand.

How do I fix code 45?

Per Microsoft's website, Error Code 45 occurs if a device that was previously connected to the computer is no longer connected. Microsoft's recommendation to resolve this problem is "to reconnect the hardware device to the computer" which should resolve the error automatically.

What is code 45 on bryant furnace?

BRYANT ERROR CODE 45

Reset power to clear lockout. Replace control if status code repeals.

What is the error code for out of service?

503 Service Unavailable. The HTTP 503 Service Unavailable server error response status code indicates that the server is not ready to handle the request. Common causes are that a server is down for maintenance or overloaded.

What does CO 45 mean on an EOB?

CO-45 marks a fee that exceeds the maximum allowable amount for a service charge. Or when those charges exceed a contracted fee arrangement. This adjustment amount cannot equal the total service or claim charge amount. The adjustment must also not duplicate provider adjustment amounts from prior payer's decisions.

What are the denial codes?

Denial codes are alphanumeric codes that are assigned by insurance companies (payers), whether private or public, to show why a specific insurance claim was denied—in other words, not paid by the insurance company. For example, CO-11 means “Error in Coding.” CO-18 means “Duplicate Claim.”

What does PR mean on an EOB?

PR (Patient Responsibility) is used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials. If the patient did not have coverage on the date of service, you will also see this code.

How to correct denial code 45?

How to Resolve Denial Code CO-45
  1. Step 1: Review the Denial. Start by examining the denial notification to understand the specific reason for the CO-45 code. ...
  2. Step 2: Check Fee Schedules. ...
  3. Step 3: Confirm Contractual Agreements. ...
  4. Step 4: Correct Billed Amounts. ...
  5. Step 5: Submit Appeal.

What is the condition code 45?

Relevant for claims rejected due to "gender marker inconsistent with procedure performed," for example pap smears performed on transgender men with a male gender marker. Was this article helpful?

How to bill Medicare benefits exhausted?

A TAR is required to bill Medi-Cal for Part A benefits exhausted. The Part B payment is entered in the Prior Payment field (Box 54) on the UB-04 claim. (Inpatient Medicare Part A coinsurance and deductible in this example were previously billed on a separate UB-04 claim for Part A covered days.)