CARC 45Fee Schedule Appealable

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement

Q: Is CARC 45 appealable?

Yes, CARC 45 is appealable with an estimated win rate of approximately 25.00%.

Quick Action: Review your payer contract; write off if correct, or appeal if the rate is wrong.

Typically seen with:CO — Contractual Obligation

~25.00%

Estimated appeal win rate for CARC 45 denials

What Does CARC 45 Mean?

CARC 45 — "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement" — is a Claim Adjustment Reason Code used by payers to indicate why a claim or service line was adjusted. This code falls under the Fee Schedule category.

Common Causes

Here are the most common reasons this denial code appears on your remittance advice:

Billed amount exceeds the payer's fee schedule or contracted rate
Out-of-network provider with no contracted rate on file
Fee schedule update not reflected in the payer's system
Medicare's physician fee schedule (MPFS) limits applied
Sequestration or other regulatory reductions applied

Is CARC 45 Appealable?

Yes, CARC 45 is appealable. With proper documentation and a well-crafted appeal, this denial code has an estimated win rate of approximately 25.00%. While the win rate is moderate, strong clinical documentation can significantly improve your chances.

How to Appeal CARC 45

Follow these steps to maximize your chances of a successful appeal:

1 Review the payer contract to verify the correct contracted rate

2 If the fee schedule rate is incorrect, submit documentation of the correct rate

3 For out-of-network denials, consider negotiating a single-case agreement

4 Verify if the reduction is a legitimate contractual adjustment or an error

5 Write off the contractual adjustment if the payment matches the contracted rate

Related RARC Codes

These Remittance Advice Remark Codes are commonly paired with CARC 45. The RARC tells you the specific reason for the adjustment.

N1 Alert: You may appeal this decision in writing within the required time limits

N115 This decision was based on a Local Coverage Determination (LCD)

N362 The number of Days or Units of Service exceeds our acceptable maximum

Appeal Letter Template

.DOCX

Customize the fields below to generate a ready-to-send appeal letter for CARC 45. Downloads as a formatted Word document.

Practice/Organization

Payer Name

Claim Number

Patient Name

Member ID

Date of Service

Denied Amount

Provider Name

NPI

Phone

Letter Body (editable)

[Date]
[Payer Name]
[Payer Address]

RE: Appeal for Claim #[Claim Number]
Patient: [Patient Name] | Member ID: [Member ID]
Date of Service: [Date of Service] | Denied Amount: $[Denied Amount]

Dear Claims Review Department,

I am writing to formally appeal the denial of the above-referenced claim, denied with CARC 45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement".

Our appeal is based on the following:

- Review the payer contract to verify the correct contracted rate
- If the fee schedule rate is incorrect, submit documentation of the correct rate
- For out-of-network denials, consider negotiating a single-case agreement
- Verify if the reduction is a legitimate contractual adjustment or an error
- Write off the contractual adjustment if the payment matches the contracted rate

We have reviewed the common reasons for this denial and can confirm that the following do not apply to this claim:

- Billed amount exceeds the payer's fee schedule or contracted rate
- Out-of-network provider with no contracted rate on file
- Fee schedule update not reflected in the payer's system
- Medicare's physician fee schedule (MPFS) limits applied
- Sequestration or other regulatory reductions applied

Recommended action: Review your payer contract; write off if correct, or appeal if the rate is wrong.

Enclosed please find supporting documentation for your review. We respectfully request reconsideration and payment of $[Denied Amount].

Sincerely,
[Provider Name]
[NPI] | [Phone]
[Practice/Organization Name]

Letter Preview

This is how your letter will look when downloaded

March 26, 2026

[Payer Name]

[Payer Address]

RE: Appeal for Claim #[Claim Number]

Patient: [Patient Name] | Member ID: [Member ID]

Date of Service: [Date of Service] | Denied Amount: $[Denied Amount]

Dear Claims Review Department,

I am writing to formally appeal the denial of the above-referenced claim, denied with CARC 45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement".

Our appeal is based on the following:

Review the payer contract to verify the correct contracted rate
If the fee schedule rate is incorrect, submit documentation of the correct rate
For out-of-network denials, consider negotiating a single-case agreement
Verify if the reduction is a legitimate contractual adjustment or an error
Write off the contractual adjustment if the payment matches the contracted rate

We have reviewed the common reasons for this denial and can confirm that the following do not apply to this claim:

Billed amount exceeds the payer's fee schedule or contracted rate
Out-of-network provider with no contracted rate on file
Fee schedule update not reflected in the payer's system
Medicare's physician fee schedule (MPFS) limits applied
Sequestration or other regulatory reductions applied

Recommended action: Review your payer contract; write off if correct, or appeal if the rate is wrong.

Enclosed please find supporting documentation for your review. We respectfully request reconsideration and payment of $[Denied Amount].

Sincerely,

[Provider Name]

[NPI] | [Phone]

[Practice/Organization Name]

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