Denial code · Last verified 2026-08-29
On a dental remittance, code CO 45 means: The billed charge exceeds the fee schedule, maximum allowable, or contracted rate — the amount above the allowed rate is adjusted off. depends: check the facts first. The adjustment itself is contractual. What is contestable is the underlying fee schedule: if the allowed amount does not match your contracted schedule, request the fee schedule the claim was priced against and dispute the pricing — that is an underpayment dispute, not a benefits appeal.
Verdict
Contractual variants of this denial are final; factual-error variants are winnable. Run the checks on this page before spending the appeal window.
The adjustment itself is contractual. What is contestable is the underlying fee schedule: if the allowed amount does not match your contracted schedule, request the fee schedule the claim was priced against and dispute the pricing — that is an underpayment dispute, not a benefits appeal.
On in-network dental claims this is the ordinary contractual write-off, not a denial. It matters when it appears unexpectedly large: a wrong fee schedule attached to your contract, a leased-network rate you did not know governed the claim, or a payer processing under the wrong network tier.
State insurance law (prompt-pay statutes + plan appeal terms)
Check the state's prompt-pay rule first — an overdue clean claim may already be accruing interest without any appeal. Then run the policy's internal appeal, and escalate to the state insurance department where deadlines were missed.
29 CFR 2560.503-1
Appeal in the patient's name (or with an authorized-representative form), demand the claim file and the specific internal rule relied on, and hold the plan to the 30/60-day clocks in writing. State prompt-pay interest and state external review do not apply to self-funded plans.
42 CFR 438.402 / 438.408
Two clocks, in order: 60 days to the plan appeal, then (after the resolution notice) the state's 90–120-day fair-hearing window. Get the enrollee's written consent early, and for members under 21 remember federal EPSDT coverage rules sit above the plan's own limits.
