Desmond Achebe

CLM-2026-9161, Medicare, Therapeutic Activities, 15 min (97530)

Written offWith me Denied claims

Billed

$797

denied Mar 27

Denial risk

40%

good odds

Appeal window

closed

nothing left to file

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Mar 27
Denied by Medicare
Bundling/Coding Error (97)
Mar 27
Heron scored it: 40% denial risk
3 factors found, appeal path chosen
Mar 27
Written off
Every route exhausted
May 23

The denial

Bundling/Coding Error, code 97

Patient: Desmond Achebe, born 1960-06-23
Payer: Medicare
Procedure: Therapeutic Activities, 15 min (97530)
Diagnosis: M62.81
Denied on: Mar 27, 2026
Assigned to: Heron

Heron says

Medicare bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Corrected claim

Everything I know about Desmond

across every queue

Everything for this patient

Open exposure

$16,910

Recovered

$16,885

9 denied claims1 prior auth5 underpayments3 backlog claims

CLM-2026-7007

97530 · underpaid 8.5%

96413 · Chemotherapy Infusion, 1st Hour

93000 · Medical Necessity

97530 · underpaid 21.7%

96413 · 13d outstanding

97530 · Pre-Auth Missing

93306 · underpaid 31.4%

97530 · 72d outstanding

73630 · 134d outstanding

73630 · Missing Information

97530 · Bundling/Coding Error

96417 · Bundling/Coding Error

97110 · Coverage Terminated

73630 · Medical Necessity

93000 · underpaid 27.3%

97110 · Medical Necessity

97110 · underpaid 27.9%

$159 short

Recovered

Nov 1