CARC 245CO · Contractual Obligation
A portion of payment was withheld as part of a provider performance or quality incentive program.
- Common causes
- The provider's contract includes a performance-based withhold, later reconciled based on quality or performance metrics.
- Suggested fix
- No claim-level action is needed; withheld amounts are typically reconciled separately based on the performance program's terms.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 245 mean?
A portion of payment was withheld as part of a provider performance or quality incentive program.
How do I resolve CARC 245?
No claim-level action is needed; withheld amounts are typically reconciled separately based on the performance program's terms.
Why does CARC 245 happen?
The provider's contract includes a performance-based withhold, later reconciled based on quality or performance metrics.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.