Appeal Template Letters

In order to assist with your reimbursement needs the Academy of Otolaryngology - Head and Neck Surgery has created template letters to assist you with denials on specific procedures. These letters are generic and act only as guidance for you to construct your appeal letters. You should use your own company letterhead/logo as well as fill in the blanks and header information. We recommend that you also submit any other relevant supporting documents (for example medical notes, operative reports etc.). Contact the Health policy department if you have any questions regarding these letters.

• 61795 Template Letter
• 69990 Template Letter
• Modifier 22 Template Letter
• Modifier 25 Template Letter
• Unlisted Procedure Template Letter