Denial code

CARC 45 denial code: meaning & whether to appeal

CARC 45: the exact X12 wording, how it is classified, and whether it is worth appealing.

Appealant EditorialX12 verified3 min read

What CARC 45 means

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.

Verbatim description from the official X12 Claim Adjustment Reason Codes list.

Classification

Routing category: not denials

Appealability verdict

Contractual adjustment — not appealable as a denial

What to know

This is a contractual adjustment between billed charges and the contracted allowance. It is not a denial, and there is no appeal right attached to the adjustment itself.

Want the appeals handled for you?

Appealant reviews your denials, writes and files the appeals, and follows through until the money posts. The fee is a share of what we recover; if nothing comes back, you owe nothing.

Join the waitlist