Sample Letter of Appeal for Low Reimbursement of CPT 90734
I am submitting this letter to formally request reconsideration of [inadequate or denied] payment for CPT®a 90734, Menactra® (Meningococcal [Groups A, C, Y and W-135] Polysaccharide Diphtheria Toxoid Conjugate Vaccine), given to my patient, [name], on [date of service]. ................
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