Owen Gallagher

CLM-2026-9029, Medicare, X-Ray Lumbar Spine, 4+ Views (72110)

DeniedWith me Denied claims

Billed

$965

denied Jul 14

Denial risk

49%

good odds

Appeal window

43d

closes Oct 12

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 14
Denied by Medicare
Bundling/Coding Error (97)
Jul 14
Heron scored it: 49% denial risk
3 factors found, appeal path chosen
Jul 14
Appeal window closes
43 days left to file
Oct 12

The denial

Bundling/Coding Error, code 97

Patient: Owen Gallagher, born 1950-01-26
Payer: Medicare
Procedure: X-Ray Lumbar Spine, 4+ Views (72110)
Diagnosis: M54.51
Denied on: Jul 14, 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

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What I sent

Corrected claim

Everything I know about Owen

across every queue

Everything for this patient

Open exposure

$17,554

Recovered

$3,366

4 denied claims1 prior auth1 underpayment2 backlog claims

AUTH-4000

96413 · Chemotherapy Infusion, 1st Hour

73630 · Medical Necessity

72110 · Bundling/Coding Error

96413 · 53d outstanding

71046 · 98d outstanding

71046 · Medical Necessity