Attention: Provider Appeals
P.O. Box 0000
New York, NY 10009
Date of Service:
Dear Appeals Department:
It is my professional opinion that the above claim was unjustly processed. This letter serves our
intent to formally appeal this claim.
Per CPT, Modifier -24 is used when the patient is seen as unrelated Evaluation and Management
Service by the same physician during a Post-Operative Period.
It is in my professional position that I appeal your denial and rejection. This E&M service is clearly
significant and unrelated during a post operative period and the physician deserves to be
reimbursed for the service she/he had rendered to your member.
Should you need medical notes to support medical necessity, please send us your request. We are
more than happy to send you our medical records/notes. Otherwise, we anticipate payments within
14 business days upon receipt of this letter of appeal.
Jennifer Doe, BSc, CCS-P
Medical Billing Manager
*** Policies and Guidelines may differ on each insurance companies, the coding and
billing I just showed is based on Medicare Part B NY-NJ and with Horizon Blue Cross
and Blue Shield of New Jersey (as per my phone conversation with them)
*** Always consult your coding books for any questions.
*** Accurate, Real-Time and Proper Medical Documentation is very important to
support medical necessity!!! Or the service has never been done!
Reference/Source: CPT Code Book 2009 (AMA) , CPT 2009 Changes an Insider's View
*** CPT codes and its descriptions are copyrights, owned, maintained and is a
trademark of the AMA (American Medical Association).
*** Always consult your CPT Code Book!
*** Get more information on clinical guidelines and policies from your local CMS
carriers and from your third party payors
*** You can purchase CPT Code books and CPT Assistants issues from the AMA's