Healthcare Error Code
Healthcare Insurance / Medical Billing
Common CMS / Medicare Issues
M130 | Missing prior authorization
Industry
Insurance
Canonical
/insurance/healthcare/error-codes/m130/
Last Updated
Feb 25, 2026
Summary
This code indicates that required prior authorization was not on file for the service.
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What This Code Means
M130 is used when CMS requires prior authorization and none is recorded. Authorization requirements are policy-driven. The absence of authorization affects payment eligibility. This code does not reflect service quality or billing accuracy.
Where Users Usually See This Code
- Medicare remittance advice
- Authorization review notices
- EOB explanations
Why This Code Appears
- Authorization not obtained
- Authorization details missing
- Authorization expired
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What Typically Happens Next
- Payment is denied or delayed
- Claim processing completes or pauses
- Appeal options may exist
What This Code Is Not
- It is not a billing format error
- It is not patient responsibility
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review authorization requirements
- □ Confirm authorization records
- □ Monitor CMS policies
Notes And Edge Cases
Authorization rules may vary by CMS program. Emergency services may follow different authorization rules.
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Related Codes
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