Wiki CO 45

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CoderKathy66

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Local Chapter Officer
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How can an OV and OMT be sent to AARP Medicare correctly? I keep geeting CO 45 Charge exceeds fee schedule/max allowable or contgracted/legislated fee arrangment. I am new to coding and can't understand why this is being denied.

thanks
 
Is it being denied completely? No payment whatsoever? Can you tell us all the codes, or upload a redacted copy of the eob?

CO-45 is usually the fee schedule adjustment. If it was 100% adjusted to zero, then there is a problem.
 
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Okay, here is a similar redacted EOB. On the first line, we billed $500 for 99215 and $152.56 is the Medicare allowed amount, and $500 minus $152.56 is $347.44, the amount of the write-off. You will see this amount listed as CO-45.

We post an adjustment of $347.44, post a payment of $122.05, and $30.51 is the copay/coinsurance, which is patient responsibility. A bill for that amount was automatically forwarded to the patient's secondary insurance by Medicare.
 
While I'm here, here is one where Medicare paid nothing, because the patient had not yet met their deductible. You would still write off $347.44, but this time you would bill the patient for $152.56, which is in both the "allowed" column and the "deductible" column (even though I cut them off when I pasted it here).

View attachment 4687
 
Now that you have examples, is the OMT being denied completely? If so, what other codes are listed with it, other than CO-45?
 
I have a general question regarding CO45 adjustment with Medicare. We have a pt that has a commercial primary insurance and Medicare secondary insurance. The commercial allows more than Medicare and Medicare shows no pt responsibility. CO45. Are we allowed to bill for the difference between primary allowable and secondary Medicare allowable to the pt? I'm pretty sure I know this answer but a discussion within our office. Thank you.
 
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