Denial Management

Dear UnitedHealthcare Medical Review Department,

Re: Claim CLM-2026-004756 — George Harris (DOB: 03/15/1958)
Denied CPT 29827 (Arthroscopic rotator cuff repair) — CO-97 Bundling

I am writing to appeal the denial of the above-referenced claim. CPT 29827 (arthroscopic rotator cuff repair) and CPT 29826 (subacromial decompression) were performed as distinct procedures during the same surgical session, appropriately reported with modifier 59 on CPT 29826.

Per CCI guidelines, these procedures represent separate and distinct surgical objectives:
- CPT 29827: Full-thickness supraspinatus tear repair using double-row suture bridge technique
- CPT 29826: Type II acromial decompression with osteophyte resection performed through a separate portal

The operative report documents separate incisions, distinct anatomic sites, and independent medical necessity for each procedure. The NCCI edits allow separate reporting of these codes when modifier 59 criteria are met.

We respectfully request reconsideration and payment of CPT 29827 at the contracted rate of $1,850.00.

Sincerely,
Dr. Sarah Chen, MD
Sunshine Orthopedics & Pain Management