CARC 45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
The provider charged more than the carrier's contracted rate. The difference is a contractual write-off — patient does not owe it.
CARC 45 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 45 means
The official X12 description is: “Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.”
In plain language: The provider charged more than the carrier's contracted rate. The difference is a contractual write-off — patient does not owe it.
Common scenarios
- In-network provider
- Negotiated rate adjustment
- Medicare fee-schedule write-off
What to do next 45
Pay only what the EOB shows as patient responsibility. If the provider tries to balance-bill you for this difference, you are protected — refer to your state insurance department. For out-of-network emergencies, NSA §2799A applies.
CARC 45 group codes explained
On the 835 ERA, CARC 45 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 45 mean?
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. In plain language: The provider charged more than the carrier's contracted rate. The difference is a contractual write-off — patient does not owe it.
Is CARC 45 appealable?
CARC 45 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Pay only what the EOB shows as patient responsibility. If the provider tries to balance-bill you for this difference, you are protected — refer to your state insurance department. For out-of-network emergencies, NSA §2799A applies.
Which group code does CARC 45 appear under?
CARC 45 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
When does CARC 45 typically appear on a denial?
Common scenarios: In-network provider; Negotiated rate adjustment; Medicare fee-schedule write-off.
What should I do if I see CARC 45 on the 835?
Pay only what the EOB shows as patient responsibility. If the provider tries to balance-bill you for this difference, you are protected — refer to your state insurance department. For out-of-network emergencies, NSA §2799A applies.
Related resources
Sources
Contact: hello@denialhelp.com