ResolveRCM generates professional appeal letters with clinical rationale, payer-specific responses, and documentation checklists. All from a simple form—no EHR integration required.
Each packet includes everything billing teams typically gather manually before submission.
FORMAL APPEAL REQUEST
To: BCBS Medical Review
Re: Reconsideration/Appeal for CPT 63030-LT on [DOS]
Patient: [PATIENT_NAME] (no PHI)
Rendering Specialty: Pain Management
Treating Provider: [PROVIDER_NAME]
Member ID/Claim #: [CLAIM_NUMBER]
Dear Medical Review Committee,
We are writing to formally appeal the denial of CPT 63030-LT for the above-referenced patient. The procedure was performed on [DOS] and was medically necessary based on the following clinical rationale...
MEDICAL DECISION MAKING SUMMARY
Problem Complexity
High - Multiple chronic conditions with acute exacerbation requiring surgical intervention
Data Reviewed
MRI imaging, prior conservative treatment records, specialist consultations, medication history
Risk Assessment
High risk - Surgical procedure with anesthesia, potential complications including infection, nerve damage
MDM Level
High Complexity (99215 equivalent)
SHORT NECESSITY STATEMENT
Patient presented with severe lumbar radiculopathy unresponsive to 6+ months of conservative treatment including physical therapy, NSAIDs, and epidural injections.
MRI confirmed L4-L5 disc herniation with nerve root compression correlating to clinical symptoms.
Surgical intervention was the only remaining option to prevent permanent nerve damage and restore function.
CODING VALIDATION NOTES
Primary CPT
63030-LT - Lumbar laminotomy, single level
Modifier -LT indicates left side procedure
Supporting ICD-10 Codes
APPEAL STRENGTH ASSESSMENT
Internal Case Summary
The patient presents with chronic lumbar disc disease with radiculopathy and thoracic spondylosis, requiring moderate-complexity E/M management. The payer denied CPT 99214 citing insufficient documentation, but the clinical record supports the code based on multiple chronic conditions, imaging review, and prescription drug management including opioid therapy monitoring.
Sample content with redacted patient information. All data shown is fictional.
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