Appeal letter · M.C. · CPT 27447 · AetnaEditable draft
To the Aetna Medical Review Department,
We are appealing the denial of claim DN-10001 (CPT 27447 — Total knee arthroplasty), issued as CARC CO-50 (Not medically necessary). The enclosed records establish medical necessity under the applicable payer policy (CPB 0660). We request that the denial be overturned and the claim reprocessed for payment.
Supporting clinical documentation is attached.
Criteria scorecard4 / 4 met
Conservative care duration
Documented in the clinical record prior to surgery.
Imaging documentation
Findings documented and consistent with the diagnosis.
Function-limiting indication
Documented, unresponsive to nonoperative care.
Provider criteria
Provider and facility criteria satisfied.
Citations
CPB 0660 — applicable medical-necessity criteria
the policy the CO-50 cited; criteria verified against the record
the policy the CO-50 cited; criteria verified against the record
Filing & appeal windowsverify per payer
Timely filing
120 days
from DOS (≈2026-04-18) · Aug 16 · 48d
Appeal — Level 1
180 days
from EOB (2026-06-02) · Nov 29 · 153d
Appeal — Level 2
Per policy
verify with payer
External review
State external review
verify with payer
Peer-to-peer
Available pre-denial
P2P · pre-decision
Submission channel
Availity
Availity
ConfidenceHigh
Criteria verified against the clinical record. Similar Aetna CO-50 appeals: 84% overturned at this practice.