53+ appeal letter templates, organized by payer and denial code.
Copy-paste letters your team can use today. Each template is filing-deadline aware, attachment-checked, and tuned to the specific payer’s appeal process. Free.
Verify before filing
Filing deadlines, appeal addresses, and policy criteria in these templates reflect typical payer behavior at publication. Payer policies update frequently and plan-level rules vary. Always cross-check the specific deadline and filing address on your EOB, and confirm current medical-policy language through the payer’s provider portal before submitting an appeal. Overturn-rate language reflects AAPC-reviewer consensus, not payer-published statistics. Benchmark figures cite MGMA 2024 and Change Healthcare 2024 reports.
Showing 53 of 53 templates
Aetna CO-197 Prior Authorization Denials in Cardiology
Why Aetna throws CO-197 prior-auth denials for cardiac cath, stress echo, and MPI. Exact fix, filing deadline, and copy-paste appeal letter.
UHC CO-197 Prior Authorization Denials in Pain Management
Why UnitedHealthcare denies CO-197 on epidurals, facet injections, and RFA. Appeal strategy, filing deadline, and copy-paste letter.
BCBS CO-197 Prior Authorization Denials in Orthopedics
BCBS prior-auth denials on orthopedic MRI, joint injections, and TKA/THA. Why they fire, how to fix, and the exact appeal letter to file.
Cigna CO-197 Prior Auth Denials in Behavioral Health
Cigna prior-auth denials on psych testing, IOP, and higher levels of care. Fix-it workflow, filing deadline, and the appeal letter that wins.
Medicare Advantage CO-197 Prior Auth Denials in Cardiology
Why Medicare Advantage plans deny cardiac procedures for missing auth. And how to appeal under CMS rules.
Aetna CO-197 Prior Auth Denials in Dermatology
Aetna's prior-auth denials for dermatology biologics (Dupixent, Skyrizi) and Mohs surgery. Exact appeal strategy and letter template.
UHC CO-50 Medical Necessity Denials in Orthopedics
UnitedHealthcare CO-50 denials on orthopedic arthroscopy, MRI, and joint surgery. What triggers them and exactly how to appeal.
Aetna CO-50 Medical Necessity Denials in Behavioral Health
Aetna's CO-50 denials on therapy frequency, psychological testing, and level-of-care disputes. Parity-backed appeal strategy that wins.
BCBS CO-50 Medical Necessity Denials in Pain Management
BCBS CO-50 denials on facet injections, medial branch blocks, and RFA. Diagnostic-block documentation that wins appeals.
Medicare CO-50 Medical Necessity Denials in Cardiology
Medicare CO-50 denials on cardiac cath, stress tests, and imaging under LCD criteria. How to appeal with the right documentation.
UHC CO-50 Medical Necessity Denials in OB/GYN
UHC CO-50 denials on HSG, infertility workup, and medically indicated ultrasound. Exact documentation and appeal letter template.
Cigna CO-50 Medical Necessity Denials in Dermatology
Cigna CO-50 denials on dermatologic procedures in the cosmetic-medical boundary. Documentation that wins and an appeal letter template.
Medicare CO-16 Missing Info Denials in Cardiology
Medicare CO-16 denials in cardiology: missing NPI, invalid POS, RARC codes explained, and the exact correction workflow.
Aetna CO-16 Missing Info Denials in Pain Management
Aetna CO-16 denials on pain management: missing PA numbers, bilateral modifiers, level of service. The corrected-claim workflow.
UHC CO-16 Missing Info Denials in Orthopedics
UHC CO-16 denials on orthopedic procedures: missing modifier 59, global period confusion, and the corrected-claim workflow.
BCBS CO-16 Missing Info Denials in Dermatology
BCBS CO-16 denials in dermatology: missing biopsy site modifiers, multi-lesion billing, and the corrected-claim template.
Medicare CO-97 Bundling Denials in Orthopedics
Medicare CO-97 bundling denials in orthopedics: global surgical periods, NCCI edits, and the modifier workflow that overturns them.
Aetna CO-97 Bundling Denials in Cardiology
Aetna CO-97 bundling denials in cardiology: EKG with E/M, stress test components, and the modifier workflow that wins.
UHC CO-97 Bundling Denials in OB/GYN Global Package
UHC CO-97 bundling on OB/GYN services inside the global obstetric package. How to unbundle legitimately with modifiers.
BCBS CO-97 Bundling Denials in Pain Management
BCBS CO-97 bundling on pain management: trigger point injections, E/M with procedures, and the modifier 25 strategy.
BCBS CO-204 Non-Covered Denials in Behavioral Health
BCBS CO-204 denials on behavioral health: experimental services, SUD treatment exclusions, and MHPAEA parity appeals.
Cigna CO-204 Non-Covered Denials in Dermatology
Cigna CO-204 denials on dermatology services at the cosmetic-medical boundary. When to appeal and the documentation that wins.
Aetna CO-204 Non-Covered Denials in OB/GYN
Aetna CO-204 denials on OB/GYN: infertility workup, elective C-section, and medical-necessity crossover appeals.
UHC CO-204 Non-Covered Denials in Pain Management
UHC CO-204 denials on prolotherapy, PRP, and stem cell injections. When appeals win and when to convert to cash-pay.
UHC CO-45 Contractual Adjustments in Cardiology
UHC CO-45 contractual adjustments in cardiology: when they're valid write-offs vs payment dispute opportunities.
Aetna CO-45 Contractual Adjustments in Orthopedics
Aetna CO-45 in orthopedics: when contractual write-offs are valid and when to dispute. Fee-schedule variance workflow.
UHC CO-197 Prior Auth Denials in OB/GYN
UHC CO-197 prior-auth denials on OB/GYN hysteroscopy, laparoscopic procedures, and advanced ultrasounds.
Medicare CO-50 Medical Necessity Denials in Behavioral Health
Medicare CO-50 denials on psychotherapy, IOP, and psych testing under LCD criteria. The redetermination pathway that wins.
Cigna CO-16 Missing Info Denials in Cardiology
Cigna CO-16 denials in cardiology: PTAN, credentialing, and documentation issues. The corrected-claim workflow.
UHC CO-97 Bundling Denials in Dermatology
UHC CO-97 bundling on dermatology biopsy and E/M same-day. The modifier 25 workflow that wins.
Humana CO-197 Prior Authorization Appeal Letter
General appeal template for Humana commercial and Medicare Advantage CO-197 denials. Standard filing window applies; verify on your EOB.
Humana CO-50 Medical Necessity Appeal Letter
General Humana CO-50 appeal template citing coverage policy criteria and documented clinical indication.
Humana CO-16 Missing Information Correction Letter
Corrected-claim cover letter for Humana CO-16 denials. Read the RARC code to identify the missing element.
Humana CO-97 Bundling Correction Letter
Corrected-claim fix for Humana CO-97 with the appropriate modifier (59, 25, 79, etc.) and distinct-service documentation.
Humana CO-204 Non-Covered Service Appeal Letter
Humana benefits-level denial appeal. Verify plan coverage before pursuing; appeal futile for true exclusions.
Humana CO-45 Fee Variance Payment Dispute
Payment dispute letter for Humana CO-45 variances. Only for contract-rate mismatches, not routine write-offs.
Tricare CO-197 Prior Authorization Appeal Letter
Tricare West/East prior-auth appeal for services requiring referral or pre-auth.
Tricare CO-50 Medical Necessity Appeal Letter
Tricare medical necessity appeal with coverage-policy-specific documentation.
Tricare CO-16 Missing Information Correction Letter
Tricare corrected-claim letter addressing missing Active Duty ID, referral number, or diagnosis specificity.
Tricare CO-97 Bundling Correction Letter
Tricare bundling fix using NCCI modifier rules and operative documentation.
Medicaid MCO CO-197 Prior Authorization Appeal Letter
Generic Medicaid managed care organization prior-auth appeal. Filing deadlines and processes vary by state.
Medicaid MCO CO-50 Medical Necessity Appeal Letter
Medicaid medical-necessity appeal citing state coverage policy and EPSDT protections for pediatric members.
Medicaid MCO CO-16 Missing Information Correction Letter
Medicaid corrected-claim letter addressing state-specific missing fields (Medicaid ID format, rendering NPI).
Medicaid MCO CO-204 Non-Covered Service Appeal Letter
Medicaid non-covered appeal with state plan coverage review and EPSDT invocation where applicable.
Workers' Comp CO-50 Causation Appeal Letter
Workers' comp causation appeal establishing work-relatedness with physician opinion and injury history.
Auto PIP/MedPay CO-50 Medical Necessity Appeal
Auto insurance PIP / Med-Pay appeal tying treatment to the motor vehicle accident with provider note.
BCBS CO-16 Missing Information Correction Letter
BCBS corrected-claim letter. BlueCard routing adds a layer of complexity when the member's home plan differs.
BCBS CO-45 Fee Variance Payment Dispute
BCBS payment dispute for contract-rate mismatches. Plan-specific contract verification required.
Medicare Advantage CO-197 General Appeal (Any Specialty)
Medicare Advantage prior-auth appeal citing CMS 2024 rule requiring MA plans to follow Traditional Medicare coverage.
Medicare CO-97 NCCI Bundling Correction Letter
Medicare bundling correction with NCCI modifier indicator 1 bypass using modifier 59 or X{EPSU}.
Medicare CO-204 Non-Covered Service Appeal Letter
Medicare non-covered denial appeal with LCD/NCD citation for covered-indication cases.
Cigna CO-97 Bundling Correction Letter
Cigna bundling fix using modifier 59 and Reimbursement Policy reference for distinct service.
Cigna CO-16 Missing Information Correction Letter
Cigna corrected-claim letter addressing PTAN, credentialing, or missing auth number.
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