What is value code 45?

Asked by: Velma Murphy  |  Last update: May 24, 2025
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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 medical value 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 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 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 Denial Code CO 45?

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.

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 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 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.

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 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 are value codes?

Note: The value code is the Medicaid Rate Code (MRC). The value code amount is the Designated State Level Medicaid Rate Code (DSLMRC), which identifies the type of facility that the patient resides and the level of care the patient receives.

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 does value code 44 mean?

The VC 44 is reported only if a provider is expecting to receive a payment after a primary payment has been made through a (preferred provider) contractual arrangement. The VC 44 should not be reported when: Providers have failed to file a proper claim to the primary payer.

What is the code 45 in EOB?

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.

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 denial code M45?

What is Denial 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.

What is Medicare 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.

What is fault code 45?

Error code 45 (Currently, this hardware device is not connected to the computer.

What is the trigger for occurrence coverage?

Under an occurrence trigger, the policy responds to claims based on when the alleged incident took place, regardless of when the claim is reported or when the lawsuit is filed.

What does PR 45 mean?

Current provider remittances reflect group code “PR” (Patient Responsibility) with an ANSI Reduction Reason Code 45. (CHARGES EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/ LEGISLATED FEE ARRANGEMENT). This. may result in a provider automatically billing the subscriber the amount not covered by the tribal plan.

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 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.”