Claim Paid at Maximum Allowed Amount

CARC/RARC Description
  • CO-45
  • PR-45
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement

 

Common Reasons for Message

  • Item or service paid Medicare allowed amount
  • Item or service paid to patient's deductible and/or coinsurance
  • Item or services paid with partial units

Next Step

  • Review claim status prior to submitting a Redetermination request, check Interactive Voice Response (IVR) or the Noridian Medicare Portal (NMP)
  • Review to see if payment went towards patient's deductible
  • Submit Appeal request - Items or services with this message have appeal rights
    • Redetermination request can be submitted with applicable supporting documentation
    • Noridian encourages submission of Redetermination requests using the Noridian Medicare Portal

View reason code list, return to Reason Code Guidance page.

 

Last Updated Nov 13, 2017