Insurance Company
Attention: Provider Appeals
P.O. Box 0000
New York, NY 10009
RE:
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
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*** 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!
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Reference/Source: CPT Code Book 2009 (AMA) , CPT 2009 Changes an Insider's View
(AMA)
*** 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
Bookstore!
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