What is the insurance code 45?

Asked by: Miss Edythe Herzog  |  Last update: August 25, 2025
Score: 5/5 (37 votes)

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 is the reason code 45 on EOB?

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 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?

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.

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33 related questions found

What does code 45 mean?

Code 45) Cause. 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 the code 45 for Medicare?

Role of CO-45 Code

One of the codes used in medical billing is CO-45. This code is used when a medical procedure or service is considered experimental or investigational and is denied by insurance providers. CO-45 is a specific HCPCS code used in medical billing to indicate a corrected Medicare replacement claim.

What is diagnosis code 45?

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 California code 45?

Libel is a false and unprivileged publication by writing, printing, picture, effigy, or other fixed representation to the eye, which exposes any person to hatred, contempt, ridicule, or obloquy, or which causes him to be shunned or avoided, or which has a tendency to injure him in his occupation. (Enacted 1872.)

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 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 are reason codes in medical billing?

These codes are typically three-character alphanumeric strings. Some common scenarios for using Claim Adjustment Reason Codes include denials, partial payments, and adjustments for contractual agreements between providers and payers.

What does CO 45 mean in billing?

CO-45 denial code is common in medical billing and can affect your revenue and cash flow. It means that your charges exceed the fee schedule or contract with the insurance company. To avoid or appeal this denial code, you should follow these steps: Review your contract terms and conditions with 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 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 Medicare condition code 45?

Condition Code 45 – Ambiguous Gender Category

Condition code 45 indicates that the claim is for a patient with ambiguous gender characteristics.

What is the reason code M45?

Remark code M45 indicates that the claim submitted has issues with the occurrence code(s) provided. This could mean that the necessary occurrence code(s) are missing, incomplete, or invalid. Occurrence codes are used to report significant events that are relevant to the claim and may affect payer processing.

What are occurrence codes in healthcare?

A code to describe to describe specific event(s) relating to this billing period covered by the claim. These codes are associated with specific date(s); refer to the occurrence code start (OCRNC_CD_START_DT) and end dates (OCRNC_CD_END_DT).

What is the medical code 45?

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 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).

What is the medical code G45?

ICD-10 code G45 for Transient cerebral ischemic attacks and related syndromes is a medical classification as listed by WHO under the range - Diseases of the nervous system .

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.

What is a code 44 for Medicare?

, condition code 44 is: For use on outpatient claims only, when the physician ordered inpatient services, but upon internal utilization review performed before the claim was originally submitted, the hospital determined the services did not meet its inpatient criteria.

What are Medicare codes?

Medicare utilizes a standardized coding system for orderly and consistent billing of patient and resident healthcare services. These unique codes are known as billing codes. Other government insurance agencies and commercial insurance companies follow Medicare's coding system as well.