Attention: Provider Appeals
P.O. Box 0000
New York, NY 10009

ID #                
Date of Service:                
Claim #

Dear Appeals Department:

As you know, the claim was originally submitted without modifer -24. We are resubmitting this
claim as a corrected claim with modifier -24.  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.

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.

It is my position to 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.

Kindly see attached corrected and resubmitted claim. We anticipate reconsideration of this
denial and claim payment soon.

Thank you.

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
Find the answer if you don't know it! ~~
there is NO excuse for Ignorance!
Sample Claim Appeal Letter without Modifier 24