Latest updates: Appeals
Update of the 2025 dollar amount in controversy required to sustain appeal rights for an Administrative Law Judge (ALJ) Hearing or Federal District Court Review
Section 1869(b)(1)(E) of the Social Security Act (the Act), as amended by Section 940 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), requires an annual…
Tutorial: Completing the Medicare Part A redetermination and clerical error reopening request form
Review our tutorial and learn how to correctly complete this form to ensure more accurate processing.
Positron emission tomography (PET) for oncologic conditions: Modifier usage
The appeals department is receiving appeals regarding the incorrect usage of modifiers associated with PET scans. Read this article to learn more about billing these services correctly.
Claims and appeals for CPT 93010 performed in emergency room setting
Please review this article regarding appeals received for CPT 93010 (electrocardiogram report) and the use of modifier 77.