45 (26)    ADJUSTMENT REASON (161.91)

Name Value
CODE 45
STATUS EFFECTIVE DATE
  • 2003-06-01 00:00:00
    STATUS:   ACTIVE
    FEE USE:   APPLICABLE
DESCRIPTION EFFECTIVE DATE
  • DESCRIPTION:   
    Charges exceed your contracted/ legislated fee arrangement.
    
  • DESCRIPTION:   
    Charge exceeds fee schedule/maximum allowable or contracted/legislated 
    fee arrangement.  (Use group Codes PR or CO depending upon liability).
    
  • DESCRIPTION:   
    Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use only with Group Codes PR or CO depending upon liability).
    
  • DESCRIPTION:   
    Charge exceeds fee schedule/maximum allowable or contracted/legislated 
    fee arrangement. Note: this 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)
    
ASSOCIATED SUSPEND CODE File: 161.27, IEN: 4
SUSPENSION DESCRIPTION
depending upon liability)