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CO-45
Recoverability: Low
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement
The difference between your billed fee and the plan's allowed amount. For in-network dentists this is the contractual write-off: not money the patient owes, and usually not money anyone can recover.
Why this happens on dental claims
- Standard PPO write-offs where the office fee exceeds the contracted schedule
- Out-of-network claims paid at the plan allowance, with a balance that is actually patient responsibility but gets posted as a write-off
- Payers applying an outdated or wrong fee schedule after a network lease or contract renegotiation
How to appeal CO-45
- Confirm your network status for that specific plan and location on the date of service, since leased networks change the contracted rate
- Compare the allowed amount on the remittance to your current contracted fee schedule
- If the payer applied the wrong schedule, request reprocessing with your contract and fee schedule attached
- If out of network, bill the patient the balance where state law and plan terms permit, rather than writing it off
How to prevent it
- Load current contracted fee schedules into the PMS annually and after any network notice
- Audit a sample of remittances each quarter to confirm allowed amounts match your contracts
How much CO-45 money is sitting in your remittances?
Drop your last 835 into the free audit. It runs in your browser, nothing uploads, and you see the answer in about a minute.