Denial codes / CO-45

Denial code 45

CO-45: Above the contracted fee (PPO write-off)

Charge exceeds the fee schedule or contracted amount.

What to doNormal PPO write-off (check the amount)
Often recoverableUsually not

The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.

Why dental offices see it

  • Normal difference between your full fee and the PPO's contracted fee.
  • The insurer applied a lower fee than your contract says.

What to do

  1. Compare the allowed amount with your contracted fee for that insurer and code.
  2. If the allowed amount is lower than your contract, ask for reprocessing with the fee schedule page attached.
  3. If it matches, the write-off is correct; do not bill the patient for it.

Stop it next time

Keep each PPO fee schedule loaded so every payment is checked against it. Owedex's free check does this with your payment files.

How many CO-45 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.

Run the free check

Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.