Priya Raman

CLM-2025-9112, Medicare, Chemotherapy Infusion, Addl Hour (96415)

RecoveredWith me Denied claims

Billed

$1,275

denied Dec 13

Denial risk

55%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$1,275

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Dec 13
Denied by Medicare
Medical Necessity (50)
Dec 13
Heron scored it: 55% denial risk
3 factors found, appeal path chosen
Dec 13
Paid in full
The money is back
Jan 28

The denial

Medical Necessity, code 50

Patient: Priya Raman, born 1955-06-04
Payer: Medicare
Procedure: Chemotherapy Infusion, Addl Hour (96415)
Diagnosis: C34.90
Denied on: Dec 13, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Medicare denies 45% of 96415 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.