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Home Practice Resources Coding and Reimbursement Coding Resources and Information Appeal Letters

Appeal Letters

Below find helpful links to commonly used letters for clinical and administrative appeals.

Clinical Appeals

  • E&M with PVR Appeal[pdf]
  • E&M Bundled with Urinalysis[pdf]
  • Gold Seed Marker Letter[pdf]
  • Peri-prostatic Rectal Spacer (Space Oar®)[pdf]
  • PTNS[pdf]
  • PTNS References[pdf]
  • Transperineal Template Guided Biopsy Appeal[pdf]
  • Transprostatic Urethral Implant (Urolift®)[pdf]
    • UroLift Bibliography[pdf]
  • Training in Ultrasound Appeal[pdf]
    • Ultrasound Policy Statement[pdf]
  • Transurethral Destruction of Prostate Tissue; By Radio-Frequency Generated Water Thermotherapy (Rezum®) Appeal Letter [pdf]
  • Urodynamics Testing Appeal[pdf]
  • Xiaflex Appeal Letter [pdf]
  • Xiaflex References[pdf]
  • Xiaflex AUA Coding Recommendations[pdf]

Administrative Appeals

  • Emergency Medical Services Appeal [pdf]
  • Authorization Appeal[pdf]
  • Prompt Payment Appeal[pdf]

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