45 Denial Code

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)
Start: 01/01/1995

Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient.

Denied. Type service/procedure code is invalid. Refer to current fee schedule for valid code.

No EOB Please resubmit with EOB in order to complete processing of the claim.