Reason Code 5OP64: Date for the Item or Service That Is Subject to Prior Authorization Is After the Expiration Decision Date

Published 07/23/2021

Reason code 5OP64 indicates that the date for the item or service that Is subject to prior authorization Is after the expiration decision date.

Reason for the Denial
The prior authorization date had expired when the service(s) were rendered.

How to Avoid This Denial

  • Services should be rendered within the 120 days of the affirmed date
  • Utilize the OPD PA calculator on the Palmetto GBA website to verify when the PA will expire

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