Forum - Questions & Answers

Aug 24th, 2016 - analis09

code being denied

What is the meaning of the code PR_45: Charges exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.

Aug 24th, 2016 - petunia 195 

re: code being denied

When I see a 45 rejection it typically means we have billed an e/m without a modifier in the global period. Without knowing more about what you have billed that would be my suggested start. Check your global period for E/M billed without a modifier.

Aug 25th, 2016 - alpjeffrey 14 

re: code being denied

CO45 or PR45 usually means that is a write off because you charged above the allowable amount.

Say you charge $130 for a 99213 office visit E&M.

The insurance only allows you $75 for that same code.

Therefore, on the EOB it will show a CO45 of $55 because you are contracted with that company to take their allowable amount instead of what you charge.

Hope that makes sense.

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