Prior authorization codes
Denver Health Medical Plan
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 38335 | COFIN SUBMIT CLAIMS THROUGH COFINITY EDI PAYER # | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| 99291 | OCE076 Trauma response critical care code without revenue code 068x and CPT | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| A0100 | Prior authorization is awaiting medical review | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| A0101 | Authorization Amount overrides Contract Amount | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| A0624 | Authorization Line Manually Denied | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| A0625 | Authorization Line Manually Pended | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| A0626 | Authorization Status Manually Set | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| D0001 | SERVICE RESPONSIBILITY OF LAB CORP ONLY | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| D6000 | The Provider is not a member of the UHC PPO Network | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| G0244 | OCE056 EM condition not met and line item date for OBS code is not 12-31 or 01-01 | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| G0378 | AP058 RESUBMIT CORRECTION - RETURN TO PROVIDER ONLY ALLOWED WITH | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| G0379 | AP058 RESUBMIT CORRECTION - RETURN TO PROVIDER ONLY ALLOWED WITH | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0010 | No Active Provider Contract | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0011 | Provider Not Active for Plan on DOS | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0012 | Invalid Approved Provider Service for Provider | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0014 | No Contract Term found for Service | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0015 | Referral Required by Contract | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0016 | No Benefit for Service | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0017 | Incorrect age for Nursery charges | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0018 | Invalid Accommodation Days | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0019 | Benefit Requires Prior Authorization | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0020 | Benefit Visit Limit Exceeded | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0021 | Benefit Dollar Limit Exceeded | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0022 | Benefit Applies to PCP Only | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0023 | Admit Date Required for Inpatient Claim | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0024 | Attending Physician Required for Inpatient Claims | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0025 | Claim Total Mismatch | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0026 | Invalid Bill Type | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0027 | Primary ICD9 Diagnostic Code Required | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0028 | Discharge Status Required for Inpatient and SNF Claims | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0029 | Interim Claim with no Initial Claim | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0030 | Duplicate Claim Line(Member/DOS/CPT(Rev)) | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0031 | Invalid CPT Modifier | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0032 | Invalid CPT/HCPCS | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0033 | Invalid Revenue Code | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0034 | Modifier required for CPT/HCPCS | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0035 | Revenue Code Requires HCPCS | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0036 | Physicians Assistant requires Modifier 80 or 27 | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0037 | CRNA requires Modifier AA | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0038 | Invalid Line Date of Service | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0039 | Invalid Start Date | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0040 | Invalid End Date | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0041 | Invalid Discharge Status | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0042 | Invalid Revenue Code for Bill Type | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0043 | Invalid HCPCS for Revenue Code | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0044 | Claim Tiers Do Not Match Referral | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0045 | Missing Primary Diagnosis | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0046 | Admit Type Required | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0047 | Discharge Status Required | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0048 | Invalid For Male | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0049 | Invalid For Female | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0050 | No Enrollment | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0051 | Duplicate Claim (Member/DOS) | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0052 | Coverage Period Insufficient for Benefit Coverage | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0053 | Member has no active enrollment on DOS | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0054 | Manually Pended Claim | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0055 | Provider is not part of Network required for Benefit | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0056 | Service is capitated to PCP or IPA | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0057 | No Attending Physician ID (Outpatient) | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0058 | Provider is Not Credentialed | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0059 | Claim amount exceeds maximum allowed during Mass Adjudication | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0060 | Negative charge on claim line | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0061 | Provider has Alert/Memos | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0062 | Provider Watch flag has been set for review | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0063 | Claim amount exceeds Maximum allowed | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0064 | Provider does not match required type | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0065 | Provider requires a specialty code | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0066 | Claim denied manually | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0067 | Electronic claim has COB | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0068 | Benefit has age restrictions | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0069 | Provider type does not match term | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0070 | PCP is solely responsible for services | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0071 | Price UB by CPT billed yes/no | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0072 | Benefit Requires Manual Review | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0073 | Contract Term Requires Manual Review | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0074 | Provider on Pay Hold | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0075 | Invalid Admit Hour | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0076 | Invalid Discharge Hour | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0077 | Claim Doesn't have any Service Lines | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0078 | Generate 1500 From EPSDT Form | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0080 | Claim payment amt exceeds max allowed for mass adjudication | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0087 | Claim payment amount exceeds maximum allowed | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0088 | Claim payment amt exceeds max allowed for mass adjudication | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0089 | EARLY INTERVENTION SERVICES (EIS) ARE DENIED, PROVIDERS MUST BILL FOR EIS THRU THE EIS TRUST FUND | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0090 | MEMBER IS DECEASED PRIOR TO DATE OF SERVICE ON CLAIM | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| M0091 | Provider not revalidated per Colorado Medicaid | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| R0008 | Claim requires manual processing | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |
| R0208 | Provider doesn't meet criteria required to provide service | 2026-07-06 | Not listed | 97% | [PDF] PENDED REASON CODES - DenverHealthMedicalPlan.org |