Important Denial Codes:

1 – Deductible amount

2 – Coins's amount

3 – Copay amount

4 - The procedure code is inconsistent with the modifier used or a required modifier is missing.
5 - The procedure code/bill type is inconsistent with the place of service.
6 - The procedure/revenue code is inconsistent with the patient's age.
7 - The procedure/revenue code is inconsistent with the patient's gender.
8 - The procedure code is inconsistent with the provider type/specialty (taxonomy).
9 - The diagnosis is inconsistent with the patient's age.
10 - The diagnosis is inconsistent with the patient's gender.
11 - The diagnosis is inconsistent with the procedure.
12 - The diagnosis is inconsistent with the provider type.

15 - authorization number is missing, invalid, or does not apply to the billed services or provider

16 – Service lack information

18 – Duplicate

19-  Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

23 - Payment adjusted because charges have been paid by another payer

26- Expenses incurred prior to coverage.
27- Expenses incurred after coverage terminated.
29 - The time limit for filing has expired.

35 - Lifetime benefit maximum has been reached.

39 - Services denied at the time authorization/pre-certification was requested.

45 - Charges exceed your contracted/ legislated fee arrangement.

47 - This (these) diagnosis(es) is (are) not covered, missing, or are invalid

49 - These are non-covered services because this is a routine exam or screening procedure done in          conjunction with a routine exam.
50 - These are non-covered services because this is not deemed a `medical necessity' by the payer.
51 - These are non-covered services because this is a pre-existing condition

96 – Non-Covered charges

97 – Benefit Included for another service

109- Claim not covered by this payer

119 - Benefit maximum for this time period or occurrence has been reached

226 – Information requested for Billing/Rendering provider

234- Procedure is not paid separately