Priya Raman

CLM-2025-9117, Medicare, Therapeutic Exercise, 15 min (97110)

RecoveredWith me Denied claims

Billed

$1,262

denied Nov 26

Denial risk

61%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$1,262

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Nov 26
Denied by Medicare
Medical Necessity (50)
Nov 26
Heron scored it: 61% denial risk
3 factors found, appeal path chosen
Nov 26
Paid in full
The money is back
Feb 7

The denial

Medical Necessity, code 50

Patient: Priya Raman, born 1955-06-04
Payer: Medicare
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Nov 26, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Medicare denies 62% of 97110 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.