| 1 | Deductible |
| 2 | Coinsurance |
| 3 | Copay |
| 4 | Modifier missing or inconsistent with procedure |
| 5 | Procedure / bill type inconsistent with place of service |
| 6 | Procedure inconsistent with patient's age |
| 7 | Procedure inconsistent with patient's sex |
| 8 | Procedure inconsistent with provider type/specialty |
| 9 | Diagnosis inconsistent with patient's age |
| 11 | Diagnosis inconsistent with procedure |
| 15 | Authorization number missing or invalid |
| 16 | Missing information or billing error — see remark codes |
| 18 | Duplicate claim or service |
| 19 | Work-related — bill workers' comp |
| 20 | Covered by liability carrier |
| 22 | Another payer may be primary (coordination of benefits) |
| 23 | Prior payer's adjudication applied |
| 24 | Covered by capitation / managed care plan |
| 26 | Service before coverage started |
| 27 | Service after coverage ended |
| 29 | Timely filing limit expired |
| 31 | Patient not identified as our insured |
| 32 | Dependent not eligible |
| 33 | No dependent coverage |
| 39 | Authorization denied |
| 40 | Not emergency / urgent care criteria |
| 45 | Charge exceeds fee schedule / contracted amount |
| 49 | Routine or preventive service not covered |
| 50 | Not medically necessary per payer |
| 51 | Pre-existing condition |
| 54 | Multiple physicians / assistant not covered |
| 55 | Experimental or investigational |
| 58 | Wrong place of service |
| 59 | Multiple / concurrent procedure rules applied |
| 89 | Professional fees removed (facility claim) |
| 90 | Ingredient cost adjustment |
| 94 | Processed in excess of charges |
| 96 | Non-covered charge |
| 97 | Bundled — paid in another service |
| 100 | Payment made to patient |
| 101 | Predetermination: anticipated payment |
| 104 | Managed care withholding |
| 107 | Related or qualifying service not paid |
| 109 | Not covered by this payer — send to the correct payer |
| 110 | Billing date before service date |
| 119 | Benefit maximum reached |
| 125 | Submission / billing error |
| 128 | Newborn's services covered on mother's claim |
| 129 | Prior processing information incorrect |
| 130 | Claim submission fee |
| 131 | Claim-specific negotiated discount |
| 133 | Pended for review |
| 136 | Prior payer's coverage rules not followed |
| 140 | Patient / insured health ID mismatch |
| 144 | Incentive adjustment |
| 146 | Diagnosis invalid for date of service |
| 150 | Level of service not supported |
| 151 | Frequency / number of services not supported |
| 167 | Diagnosis not covered |
| 170 | Not paid when performed by this provider type |
| 171 | Not paid when performed in this facility type |
| 181 | Procedure code invalid on date of service |
| 182 | Modifier invalid on date of service |
| 183 | Referring provider not eligible |
| 185 | Rendering provider not eligible |
| 189 | Not otherwise classified code — use a specific code |
| 190 | Included in SNF qualified-stay allowance |
| 193 | Original payment decision maintained |
| 197 | Precertification / authorization absent |
| 198 | Precertification / authorization exceeded |
| 199 | Revenue code and procedure code mismatch |
| 204 | Not covered under patient's current benefit plan |
| 206 | NPI missing or invalid |
| 208 | NPI doesn't match |
| 209 | Disallowed amount — may not bill the patient |
| 226 | Requested information not provided or insufficient |
| 227 | Information requested from patient not provided |
| 234 | Procedure not paid separately |
| 235 | Sales tax |
| 236 | Procedure / modifier combination not allowed (NCCI) |
| 242 | Out-of-network provider |
| 243 | Services not authorized by network provider |
| 252 | Additional documentation required |
| 253 | Sequestration reduction |
| 270 | Covered under medical plan, not dental |
| 272 | Coverage / program guidelines not met |
| 273 | Coverage / program guidelines exceeded |
| 275 | Prior payer's patient responsibility not covered |
| 288 | Referral absent |
| A1 | Claim / service denied |
| A6 | Prior hospitalization / 30-day transfer requirement not met |
| B1 | Non-covered visits |
| B4 | Late filing penalty |
| B7 | Provider not certified for this service on this date |
| B9 | Patient enrolled in hospice |
| B10 | Allowed amount reduced: component of basic procedure |
| B11 | Transferred to the proper payer |
| B12 | Services not documented in records |
| B13 | Previously paid |
| B15 | Requires a qualifying service that was not paid |
| B16 | New patient qualifications not met |
| B20 | Procedure / service partially or fully furnished by another provider |
| B22 | Payment adjusted based on diagnosis |
| P1 | State-mandated requirement for property & casualty |
| W1 | Workers' comp state fee schedule adjustment |