If you are experiencing inappropriate denials of certain procedural codes, the AAOS is working to support you in your appeals to payors. We have developed appeal letter templates and gathered a range of informational resources, such as FAQs, AAOS Complete Global Service Data content, and letters sent on behalf of AAOS members to the Centers for Medicare and Medicaid Services (CMS).
Drug Delivery Device Appeal Letter template
Appeal letter template may be used to appeal inappropriate denials for drug-delivery devices, CPT codes 27000 to 27005 reported in conjunction with other procedures that may be performed at the same time. The letter offers the framework needed to support appeals for denied procedures and may be altered to fit the specific situation.
Resources for Evaluation and Management (E/M) with Modifier 25
The resources below are intended to provide you with strategic knowledge on reporting of E/M services and support your efforts in appeals for inappropriate denials.
Modifier 25 Resource
Comprehensive chart on the proper usage of modifier 25 with E/M codes. This resource includes CPT and CMS guidelines.
Appeal Letter Templates
Our appeal letter templates may be used to appeal inappropriate denials for E/M services appended with the Modifier 25, when reported in conjunction with other E/M codes or other minor procedure codes on the same date of service. The two appeal letter templates offer the framework needed to support appeals for denied procedures and may be altered to fit the specific situation.