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Contractual / underpayment review for underpaymentDenial Code CARC 45: Charge exceeds the fee schedule / maximum allowable or contracted amount
CARC 45 means: charge exceeds the fee schedule / maximum allowable or contracted amount. Here's what it means in plain English, why it happens, and how it's worked toward payment.
CARC 45 — Charge exceeds the fee schedule / maximum allowable or contracted amount. Denial family:
Contractual / underpayment.
Why you get a CARC 45 denial
- The billed charge is above the contracted/allowed amount (often a normal contractual adjustment).
- But the payer may have paid below the actual contracted rate — a hidden underpayment.
- A fee-schedule or contract-load error on the payer's side.
How to fix or appeal CARC 45
- Compare the payment to your contracted/allowed rate for that code.
- If paid at contract, it's a routine adjustment — no action.
- If paid below contract, file a contract-variance / underpayment appeal with the fee schedule.
CARC 45 is often just a write-off — but it can hide underpayments worth recovering when the payment is below your contracted rate.
Have a stack of CARC 45 (or other) denials piling up?
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CARC 45 — FAQ
Is CARC 45 always a write-off?
No. It's frequently a normal contractual adjustment, but it can mask an underpayment — when the payer pays less than your contracted rate. A contract-variance review catches those.
How do I know if I'm being underpaid?
Compare each payment to your contracted fee schedule by code. Systematic variances below contract are recoverable — that's exactly what a forensic A/R audit surfaces.