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 appears on the 835 ERA (Electronic Remittance Advice) that the payer returns after claim adjudication. It explains a reduction, denial, or payment adjustment to your billing team. For your practice, the question is workflow: identify the pattern, route the denial to the right resolution path (rebill, appeal, write-off), and recover what's recoverable without burning RVU time on dead-end fights.
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
Practice workflow for CARC X 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
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