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Template Letter of Medical Necessity for United Healthcare

WEBUnited Healthcare Pre-Authorization. I am writing this letter to request pre-authorization for Jane Doe to perform an osteochondral allograft transplantation surgery. This letter …

Actived: 7 days ago

URL: https://portal.jrfortho.org/insurance/files/2019_United_Healthcare_-_LOMN.pdf

Template Letter of Medical Necessity for BlueCross BlueShield …

WEBThis letter provides information regarding the patient’s medical history, current condition, diagnosis, and treatment rationale to support the medical necessity for an osteochondral …

Category: Medical Go Health

Template Letter of Medical Necessity for BlueCross BlueShield …

WEBOn February 12, 2016, I performed a diagnostic arthroscopy to evaluate the status of Jane Doe’s knee, which has been included with this prior authorization submission. A full …

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Template Letter of Medical Necessity for Florida Blue

WEBThis procedure is medically necessary and meets all the criteria outlined in the Florida Blue medical policy (Policy 02-20000-65). Additionally, in the clinical community, …

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Template Letter of Medical Necessity for BlueCross BlueShield …

WEBOn February 12, 2019, I performed a diagnostic arthroscopy to evaluate the status of Jane Doe’s knee, which has been included with this prior authorization submission. A large, …

Category: Health Go Health

Template Letter of Medical Necessity for Blue Cross Blue …

WEBOn February 12, 2016, I performed a diagnostic arthroscopy to evaluate the status of Jane Doe’s knee, which has been included with this prior authorization submission. A full …

Category: Health Go Health

Template Letter of Medical Necessity for BlueCross BlueShield …

WEBJane Doe is a skeletally mature 35-year-old female with a BMI of 30, who was first presented to my care in January 2016. The patient described pain and popping …

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Template Letter of Medical Necessity for Humana

WEBOn January 12, 2019, I performed a diagnostic arthroscopy to evaluate the status of Jane Doe’s knee. The documentation of the arthroscopy is included with this prior …

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Template Letter of Medical Necessity for Aetna

WEBAetna Pre-Authorization. I am writing this letter to request pre-authorization for Jane Doe to perform an osteochondral allograft transplantation surgery. This letter …

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Template Letter of Medical Necessity for Humana

WEBOn February 12, 2016, I performed a diagnostic arthroscopy to evaluate the status of Jane Doe’s knee, which has been included with this prior authorization submission. A large, …

Category: Health Go Health

Template Letter of Medical Necessity for Highmark

WEBThis procedure is medically necessary and meets all the criteria outlined in the Highmark. medical policy (Policy S-185-007 or S-185-013). Additionally, in the clinical community, …

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Template Letter of Medical Necessity for BlueShield of California

WEBThis procedure is medically necessary and meets all the criteria outlined in the BlueShield of California medical policy (Policy 7.01.78). Additionally, in the clinical community, …

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Template Letter of Medical Necessity for Anthem BCBS

WEBThis procedure is medically necessary and meets all the criteria outlined in the Anthem BCBS medical policy (Policy CG-SURG-67). Additionally, in the clinical community, …

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BlueCross BlueShield of Tennessee Medical Policy Manual

WEBOsteochondral fresh allografting of focal articular cartilage lesions is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness …

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Template Letter of Medical Necessity for Aetna

WEBfull thickness lesion (Outerbridge Grade III) was found on the patient’s right lateral femoral condyle with an estimated diameter of 2 cm.The defect is discrete, single, and unipolar …

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Knee Surgery: Arthroscopic and Open Procedures

WEBCMM 312 Knee Surgery-Arthroscopic and Open Procedures 312.1 Definitions 3 312.2 Indications and Non -Indications 4 Diagnostic Arthroscopy 5

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Medical Policy Reference Manual Medical Policy Treatment of …

WEB3 experts do seem to agree that osteochondral grafting for ankle defects may end up being the preferred treatment approach for patients who are younger and more active.

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Coverage Policy Manual

WEBMeets Primary Coverage Criteria Or Is Covered For Contracts Without Primary Coverage Criteria. Defect size is greater than 2.5cm2; and BMI is less than 35; and Knee must be …

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