Service Type Codes (UM03)

UM03 — Service Type Code (X12 element 1365)

UM (Health Care Services Review Information); same element is used in EQ01 of the 270/271 · 278 Health Care Services Review (005010X217)

Draft — pending verification

This reference entry has not yet been verified against its authoritative source (X12 element 1365 external code list — verify against licensed copy). Do not rely on it for production configuration until this notice is removed.

Code	Name	Summary
1	Medical Care	The broadest service type: general medical care not better described by a more specific code.
2	Surgical	Surgical services — one of the highest-volume prior-auth categories, since most plans require authorization for elective inpatient surgery and a defined list of outpatient procedures.
3	Consultation	Consultation services — a request to certify an evaluation by another practitioner, commonly used alongside specialty care review workflows in gatekeeper plans.
4	Diagnostic X-Ray	Diagnostic radiography.
5	Diagnostic Lab	Diagnostic laboratory services.
6	Radiation Therapy	Radiation oncology services — a near-universal prior-auth category given cost and treatment-plan variability.
7	Anesthesia	Anesthesia services.
8	Surgical Assistance	Assistant-at-surgery services.
12	Durable Medical Equipment Purchase	Purchase of durable medical equipment.
18	Durable Medical Equipment Rental	Rental of durable medical equipment.
20	Second Surgical Opinion	Second surgical opinion services.
33	Chiropractic	Chiropractic services.
35	Dental Care	Dental services.
40	Oral Surgery	Oral surgery services — the medical/dental boundary category, frequently subject to review precisely because coverage responsibility (medical versus dental benefit) has to be determined alongside medical necessity.
42	Home Health Care	Home health services.
45	Hospice	Hospice services.
48	Hospital - Inpatient	Inpatient hospital services — the core admission-review category.
50	Hospital - Outpatient	Outpatient hospital services.
54	Long Term Care	Long-term care services.
62	MRI/CAT Scan	Advanced imaging (MRI, CT).
65	Newborn Care	Newborn care services.
68	Well Baby Care	Well-baby (preventive infant) care.
73	Diagnostic Medical	Diagnostic medical services not covered by the imaging or lab categories — sleep studies and similar diagnostic workups often travel here, several of which are common prior-auth targets.
76	Dialysis	Dialysis services.
78	Chemotherapy	Chemotherapy services.
80	Immunizations	Immunization services.
81	Routine Physical	Routine physical examinations.
82	Family Planning	Family planning services.
86	Emergency Services	Emergency services.
88	Pharmacy	Pharmacy services.
93	Podiatry	Podiatry services.
98	Professional (Physician) Visit - Office	Office-based physician visits.
99	Professional (Physician) Visit - Inpatient	Inpatient physician visits.
A4	Psychiatric	Psychiatric services.
A6	Psychotherapy	Psychotherapy services.
AD	Occupational Therapy	Occupational therapy.
AE	Physical Medicine	Physical medicine services — the category physical therapy review commonly travels under.
AF	Speech Therapy	Speech therapy services.
AG	Skilled Nursing Care	Skilled nursing care.
AI	Substance Abuse	Substance use disorder services.
AL	Vision (Optometry)	Vision/optometry services.
BG	Cardiac Rehabilitation	Cardiac rehabilitation.
MH	Mental Health	Mental health services (umbrella category).
UC	Urgent Care	Urgent care services.