| Code | Description | 5010_Equiv |
| 35 | Out of Network | 09 |
| 36 | Testing not Included | 0A |
| 37 | Request Forwarded To and Decision Response Forthcoming From and External Review Organization | 0B |
| 41 | Authorization/Access Restrictions | 0C |
| 82 | Not Medically Necessary | 0F |
| 83 | Level of Care Not Appropriate | 0G |
| 84 | Certification Not Required for this Service | 0H |
| 85 | Certification Responsibility of External Review Organization | 0J |
| 86 | Primary Care Service | 0K |
| 87 | Exceeds Plan Maximums | 0L |
| 88 | Non-covered Service | 0M |
| 89 | No Prior Approval | 0N |
| 90 | Requested Information Not Received | 0P |
| 91 | Duplicate Request | 0Q |
| 92 | Service Inconsistent with Diagnosis | 0R |
| 96 | Pre-existing Condition | 0S |
| 98 | Experimental Service or Procedure | 0T |
| E8 | Requires Medical Review | 0V |
| 53 | Inquired Benefit Inconsistent with Provider Type | 0X |
| 69 | Inconsistent with Patient's Age | 0Y |
| 70 | Inconsistent with Patient's Gender | 0Z |
