Medicare Advantage denied it. The LCD covers it.
Find the governing LCD, check the record against every criterion, and get a reconsideration letter that cites 42 CFR 422.101(b).
In development. Join the waitlist to hear first and to help decide which items come next.
Most MA denials never get appealed. Most appeals win.
Source: KFF, Jan. 28, 2026. Overturns include partial reversals. In a 2019 sample, HHS-OIG found 13% of MA prior-auth denials met Medicare coverage rules (OEI-09-18-00260).
The rule is on your side. Under 42 CFR 422.101(b), MA plans must follow traditional Medicare's NCDs, LCDs and general coverage rules. A plan may use its own criteria only when Medicare's are "not fully established" ((b)(6)), and must publish them when it does.
The hard part is the work in between: finding the right LCD and policy article, checking the version, turning the documentation section into a checklist, and writing a letter that maps every criterion to evidence. With 60 days and a full queue, that work is why denials get written off.
How it works
Enter the denial
The HCPCS Level II code, the diagnosis code and the plan's stated reason. No patient information.
See the rule and check the record
The governing LCD, its policy article and any NCD, each with its revision and effective date. Every criterion and documentation requirement becomes a checklist you tick against the chart.
Get the letter
- Each criterion mapped to your evidence
- The 422.101(b) and (b)(6) argument
- A request for any internal criteria the plan used
- A request for review by a physician with appropriate expertise (422.590(h))
Included at launch
| Category | Example HCPCS | LCD / policy article |
|---|---|---|
| Continuous glucose monitors (non-adjunctive) | E2103 A4239 | L33822 / A52464 |
| CPAP for obstructive sleep apnea | E0601 E0562 A7030 | L33718 / A52467 · NCD 240.4 |
| Home oxygen | E1390 E1392 E0431 E0439 | L33797 / A52514 · NCD 240.2 |
| Power wheelchairs (Group 2 standard) | K0822 K0823 | L33789 / A52498 · NCD 280.3 |
| Semi-electric hospital beds | E0260 E0261 | L33820 / A52508 · NCD 280.7 |
Not included: CPT procedures, commercial plans, Part D drugs.
Planned pricing
Prices we plan to launch with. Waitlist members get a founding price.
Per letter
One LCD lookup, checklist and letter. For the occasional denial.
Join the waitlistStop writing off the denials the LCD covers.
Join the waitlist and we'll email you at launch. You'll also get the free guide, "Medicare Advantage denied it, but the LCD covers it: how to appeal," right away: read it now.
Questions
Do you store patient data? Is this HIPAA-compliant?
It's being designed so patient information never needs to leave your browser: you enter codes and the plan's denial reason, and patient details are filled into the letter on your own computer. We'll publish the details before launch.
Which items does it cover?
At launch: CPAP, home oxygen, non-adjunctive CGMs, Group 2 standard power wheelchairs and semi-electric hospital beds, under the DME MAC LCDs listed above. More categories follow what founding customers ask for.
Does it cover CPT procedures or commercial plans?
Not at launch. It starts with HCPCS Level II items, and it covers Medicare Advantage only, because the requirement to follow NCDs and LCDs (42 CFR 422.101(b)) applies to MA plans.
How accurate is it? Is the letter legal advice?
Every criterion is quoted or summarized from the published LCD, policy article or NCD, with its revision, effective date and a link to the CMS Medicare Coverage Database. The kit doesn't decide coverage or guarantee an overturn, and it isn't legal advice. You review, edit and sign every letter.
Who can file the appeal?
The enrollee, a representative with a CMS-1696, the treating physician (pre-service, with notice to the enrollee), or a non-contract provider that signs a Waiver of Liability (payment denials). In-network providers usually take their own payment disputes through the plan's contract process. The kit shows which attachments each route needs.
What are the deadlines?
- You file within 60 calendar days of receiving the denial notice.
- The plan decides within 30 days for a standard pre-service request, 60 days for payment, and 72 hours for an expedited request.
- If the plan upholds the denial, it must forward the case to the Independent Review Entity automatically.
42 CFR 422.582, 422.590.