| Code | Description |
| 35 | Out of Network |
| 36 | Testing not Included |
| 37 | Request Forwarded To and Decision Response Forthcoming From and External Review Organization |
| 41 | Authorization/Access Restrictions |
| 53 | Inquired Benefit Inconsistent with Provider Type |
| 69 | Inconsistent with Patient's Age |
| 70 | Inconsistent with Patient's Gender |
| 82 | Not Medically Necessary |
| 83 | Level of Care Not Appropriate |
| 84 | Certification Not Required for this Service |
| 85 | Certification Responsibility of External Review Organization |
| 86 | Primary Care Service |
| 87 | Exceeds Plan Maximums |
| 88 | Non-covered Service |
| 89 | No Prior Approval |
| 90 | Requested Information Not Received |
| 91 | Duplicate Request |
| 92 | Service Inconsistent with Diagnosis |
| 96 | Pre-existing Condition |
| 98 | Experimental Service or Procedure |
| E8 | Requires Medical Review |
| XX | Invalid Auth Request - Discard Request - Non HIPAA Code |
