Teodora Petrova

CLM-2026-9100, BCBS, Manual Therapy, 15 min (97140)

RecoveredWith me Denied claims

Billed

$1,285

denied Jan 30

Denial risk

65%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$1,285

the money is back

What I did

and what comes next

Claim reached Heron
Entered by hand
Jan 30
Denied by BCBS
Medical Necessity (50)
Jan 30
Heron scored it: 65% denial risk
3 factors found, appeal path chosen
Jan 30
Paid in full
The money is back
Apr 29

The denial

Medical Necessity, code 50

Patient: Teodora Petrova, born 1983-03-24
Payer: BCBS
Procedure: Manual Therapy, 15 min (97140)
Diagnosis: M54.2
Denied on: Jan 30, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

BCBS denies 41% of 97140 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.