Denial Code CO-152

Reconsideration request letter

Use this reconsideration letter when filing a clinical appeal. Customize the clinical narrative with specific policy criteria before sending. Consider requesting a peer-to-peer review if the payer offers one.

[Your Practice Letterhead]
[Date]

[Payer Name]
Claims Reconsideration Department
[Payer Address]

Re: Request for Reconsideration, Denial Code CO-152
Patient: [Patient Name]
Member ID: [Member ID]
Claim Number: [Claim Number]
Date of Service: [DOS]

To Whom It May Concern:

We are requesting reconsideration of the above claim, which was returned with denial code CO-152 (Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present).

Please review the attached documentation. We are providing the materials below so that you can determine whether additional information is needed, whether the claim can be reprocessed on the current record, or whether the denial was correctly applied.

Supporting documentation attached:
• Office or operative notes for the date of service
• Relevant imaging, laboratory, or diagnostic results
• Sections of the payer's coverage policy that apply to this service (cite by policy name and section number)
• Physician narrative addressing each medical-necessity criterion in the applicable policy

Please provide a determination within the applicable review period — typically 30 to 45 days for commercial payers and 60 to 120 days for Medicare redetermination. If additional information would help resolve this claim, please contact us at the number below.

Sincerely,
[Provider Name or Billing Manager]
[NPI / TIN]
[Contact Phone] · [Email]

---
This template is a starting point. The biller or provider is responsible for reviewing the specific claim, confirming that the billed services are supported by documentation, and customizing any clinical narrative before sending. Verify the current reconsideration/appeal address and timeframes in the payer's provider manual.

CO-152 FAQ