What does 68 mean in UM03?

68 (Well Baby Care): Well-baby (preventive infant) care. Essentially never subject to prior authorization; included in the reference because the code appears in the shared 1365 code list and occasionally shows up in misrouted requests.

UM03 — Service Type Code (X12 element 1365)

68 — Well Baby Care

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.

How 68 is used

Rarely appropriate in a 278; presence in a prior-auth request usually indicates an intake mapping error worth flagging in triage.

Example

A misconfigured intake portal sends UM03 = 68 for a service that requires no review.

Where it lives in the transaction

68 is a value of UM03 — Service Type Code (X12 element 1365), carried in the UM (Health Care Services Review Information); same element is used in EQ01 of the 270/271 of the 278 Health Care Services Review (005010X217). For the payer-side view of how PA Bridge normalizes these codes across X12 and FHIR intake, see the articles section.