NCCI unbundling appeal

{{your_name}} {{your_address}} {{provider_name}} Billing Department {{provider_address}} Re: NCCI unbundling dispute - account {{your_account}}, date of service {{visit_date}}, claim {{claim_or_invoice}} To whom it may concern, I'm disputing the separate billing of CPT codes {{primary_code}} and {{unbundled_code}} on the above account. Per CMS National Correct Coding Initiative (NCCI) Procedure-to-Procedure edits, these codes are an unbundling pair: when performed together, only {{primary_code}} should be reported. The additional {{unbundled_amount}} billed for {{unbundled_code}} is therefore improper. This is not a matter of opinion; the NCCI edit tables are publicly published by CMS and updated quarterly. If a modifier (e.g. 59, XU) was applied to override the edit, the medical-record documentation must support a distinct procedural service — please furnish that documentation alongside any response that disputes my position. I'm requesting: 1. Reversal of the {{unbundled_amount}} {{unbundled_code}} charge. 2. A corrected itemized statement. 3. If you believe a modifier override is warranted, the supporting documentation per CMS NCCI Policy Manual, Chapter 1. Please respond in writing within 30 days. Sincerely, {{your_name}}