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[Insert Doctor’s Letterhead]
[Template Appeal Letter Aetna CPT® code 97140 Manual Therapy Techniques]
[Insert Date]
[Insert Address]

Patient name:
Claim #:
Policy #:
Group #:

[Insert Date of Service]
[Insert Claim #]
[Insert Patient’s Policy #]
[Insert Patient’s Group #]

To whom it may concern:
I reviewed your correspondence regarding the above named patient’s treatment on [Insert Date(s) of Service].
The [Select: letter/EOB] explains that payment for CPT® code 97140, manual therapy techniques, is not
allowed based on McKesson “clinical edit clarifications.” We were informed by Aetna that this edit was used to
develop Aetna’s policy change, implemented on March 1, 2013, which states “Currently, procedure 97140 is not
recommended for separate payment when submitted with procedure 98940-98943. Modifiers 25 and 59 do not
override this edit.” However, CPT® coding guidelines support performing these procedures on the same date
of service only when they are performed upon separate ana