Ravi Menon

CLM-2026-9121, Aetna, Therapeutic Exercise, 15 min (97110)

RecoveredWith me Denied claims

Billed

$1,631

denied Jan 3

Denial risk

57%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$1,631

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jan 3
Denied by Aetna
Medical Necessity (50)
Jan 3
Heron scored it: 57% denial risk
3 factors found, appeal path chosen
Jan 3
Paid in full
The money is back
Apr 24

The denial

Medical Necessity, code 50

Patient: Ravi Menon, born 1987-01-14
Payer: Aetna
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Jan 3, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Aetna denies 38% 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.