Desmond Achebe

CLM-2025-9006, Medicare, Therapeutic Exercise, 15 min (97110)

RecoveredWith me Denied claims

Billed

$875

denied Dec 28

Denial risk

70%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$875

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Dec 28
Denied by Medicare
Medical Necessity (50)
Dec 28
Heron scored it: 70% denial risk
3 factors found, appeal path chosen
Dec 28
Paid in full
The money is back
Mar 18

The denial

Medical Necessity, code 50

Patient: Desmond Achebe, born 1960-06-23
Payer: Medicare
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Dec 28, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Medicare denies 59% 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.