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Code : 01
Description : Price Authorization Expired
Dates : Start: 01/10/2001
Code : 02
Description : Price authorization no longer required
Dates : Start: 01/10/2001
Code : 03
Description : Product not on the price authorization
Dates : Start: 01/10/2001
Code : 04
Description : Authorized Quantity Exceeded
Dates : Start: 01/10/2001
Code : 05
Description : Special Cost Incorrect
Dates : Start: 01/10/2001
Code : 06
Description : No Credit Allowed
Dates : Start: 01/10/2001
Code : 07
Description : Administrative Cancellation
Dates : Start: 01/10/2001
Code : 08
Description : Unit resale higher than authorized
Dates : Start: 01/10/2001
Code : 09
Description : Out of Network
Dates : Start: 01/10/2001
Code : 0A
Description : Testing not Included
Dates : Start: 01/10/2001
Code : 0B
Description : Request Forwarded To and Decision Response Forthcoming From an External Review Organization
Dates : Start: 01/10/2001
Code : 0C
Description : Authorization/Access Restrictions
Dates : Start: 01/10/2001
Code : 0D
Description : Requires PCP authorization
Dates : Start: 01/10/2001
Code : 0E
Description : Provider is Not Primary Care Physician
Dates : Start: 01/10/2001
Code : 0F
Description : Not Medically Necessary
Dates : Start: 01/10/2001
Code : 0G
Description : Level of Care Not Appropriate
Dates : Start: 01/10/2001
Code : 0H
Description : Certification Not Required for this Service
Dates : Start: 01/10/2001
Code : 0J
Description : Certification Responsibility of External Review Organization
Dates : Start: 01/10/2001
Code : 0K
Description : Primary Care Service
Dates : Start: 01/10/2001
Code : 0L
Description : Exceeds Plan Maximums
Dates : Start: 01/10/2001
Code : 0M
Description : Non-covered Service
Dates : Start: 01/10/2001
Code : 0N
Description : No Prior Approval
Dates : Start: 01/10/2001
Code : 0P
Description : Requested Information Not Received
Dates : Start: 01/10/2001
Code : 0Q
Description : Duplicate Request
Dates : Start: 01/10/2001
Code : 0R
Description : Service Inconsistent with Diagnosis
Dates : Start: 01/10/2001
Code : 0S
Description : Pre-existing Condition
Dates : Start: 01/10/2001
Code : 0T
Description : Experimental Service or Procedure
Dates : Start: 01/10/2001
Code : 0U
Description : Additional Patient Information required
Dates : Start: 01/10/2001
Code : 0V
Description : Requires Medical Review
Dates : Start: 01/10/2001
Code : 0W
Description : Disposition pending review
Dates : Start: 01/10/2001
Code : 0X
Description : Service Inconsistent with Provider Type
Dates : Start: 01/10/2001
Code : 0Y
Description : Service inconsistent with Patient's Age
Dates : Start: 01/10/2001
Code : 0Z
Description : Service inconsistent with Patient's Gender
Dates : Start: 01/10/2001
Code : 10
Description : Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months)
Dates : Start: 01/10/2001
Code : 11
Description : Pricing
Dates : Start: 01/10/2001
Code : 12
Description : Patient is restricted to specific provider
Dates : Start: 01/10/2001
Code : 13
Description : Service authorized for another provider
Dates : Start: 01/10/2001
Code : 14
Description : Plan/contractual guidelines not followed
Dates : Start: 01/10/2001
Code : 15
Description : Plan/contractual geographic restriction
Dates : Start: 01/10/2001
Code : 16
Description : Inappropriate facility type
Dates : Start: 01/10/2001
Code : 17
Description : Time limits not met
Dates : Start: 02/01/2002
Code : 18
Description : Notification received
Dates : Start: 06/01/2002
Code : 19
Description : Cosmetic
Dates : Start: 06/01/2002
Code : 20
Description : Once in a lifetime restriction applies
Dates : Start: 02/01/2004
Code : 21
Description : Transport Request Denied
Dates : Start: 06/01/2004
Code : 22
Description : Ambulance Certification Segment information doesn't correspond to Transport Address Segment
Dates : Start: 06/01/2004
Code : 23
Description : Mileage cannot be computed based on data submitted
Dates : Start: 06/01/2004
Code : 24
Description : Computed mileage is inconsistent with transport information or service units submitted
Dates : Start: 06/01/2004
Code : 25
Description : Services were not considered due to other errors in the request.
Dates : Start: 06/06/2010
Code : 26
Description : Missing Provider Role
Dates : Start: 06/05/2011

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