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RevetraCaseLBZWSUCardiac stress test, CPT 93351
The patient is a 50-year-old male who presented to cardiology outpatient services on February 23, 2026, with substernal chest pressure triggered by moderate exertion. Relevant past medical history includes hypertension controlled on lisinopril[1], hyperlipidemia with a recent LDL of 142 mg/dL, and a strong family history of premature coronary artery disease[2].
Three illustrative cases
The probability score, the excerpt, and the cited sources are exactly what a real session produces — for cases shaped like these.
Session preview · Patient 1
CPT 72148 · A major national PPO insurer
Lumbar spine MRI without contrast
The insurer said the patient's back pain hasn't been documented long enough to justify imaging.
Mr. [Patient 1] presents with subacute lumbar pain refractory to a documented six-week trial of conservative management, including NSAIDs and structured physical therapy as recorded in the primary care progress note dated [date]. The American College of Radiology Appropriateness Criteria for low back pain explicitly designate advanced imaging as "Usually Appropriate" (rating 7) for patients whose symptoms persist beyond six weeks of conservative therapy [1]. CMS coverage guidance for advanced spinal imaging similarly establishes medical necessity once a documented conservative trial has failed and the clinical examination supports a structural etiology [2]. The criteria the insurer cites — "duration of symptoms inadequate to justify advanced imaging" — does not match the documented timeline; the medical record establishes more than six weeks of symptoms with conservative-management failure. The requested imaging is therefore medically necessary under the carrier's own published policy and the established standard of care.
- [1]ACR Appropriateness Criteria — Low Back Pain (American College of Radiology)
- [2]CMS National Coverage Determination — advanced spinal imaging
Scenarios constructed to demonstrate the product. Not real patients or insurer decisions. Probability scores are model estimates for the scenario described; results vary case-by-case.
Why denied
The insurer said the patient's back pain hasn't been documented long enough to justify imaging.
Outcome (published range)
In published statistics, MRI denials on medical-necessity grounds are overturned in roughly 60–75% of appeals when supported by clinical documentation.
Source: KFF analysis of CMS appeals data
Why denied
The insurer decided the chest pain the patient went to the ER for didn't qualify as an emergency after the fact.
Outcome (published range)
Retrospective ED downgrade appeals citing the prudent-layperson standard are upheld at meaningful rates when presenting symptoms could plausibly have indicated a serious condition.
Source: Public ACEP / state-DOI reviews of ED downgrade appeals
Why denied
The insurer classified the procedure as cosmetic; the patient's records don't document a functional vision impairment.
Outcome (published range)
Cosmetic-classification denials without documented functional impairment have low success rates on appeal. In this scenario, our recommendation would be a refund and a consult with a prior-authorization specialist before re-submitting.
Source: CMS appeals statistics + payer policy bulletins for blepharoplasty coverage
How we verify every citation
AI can invent plausible-sounding policy language. Revetra is built so that an invented claim cannot reach your letter.
Every claim cites a source
Each paragraph's [1], [2] markers point to a real passage we indexed — your plan's policy language, CMS guidelines, or clinical criteria. Citations trace back to sources you can read, not to the model's memory.
A second model checks each one
An independent verification pass compares every cited sentence against its source passage. If a source contradicts a claim, the section is rolled back and redrafted — not patched over.
Export is blocked until it all passes
Every section must pass citation verification before the letter can be exported. The references list shows a verified check per citation, so you can see exactly what your appeal stands on before you send it.
What you get when you pay
Free
See whether this fight is worth picking
A probability score, a plain-English explanation of the denial, and a list of the policy criteria your case might cite — so you know what you're up against before you commit.
Paid · $49
A complete, mailable appeal letter
Everything in Free, plus a fully drafted appeal letter (PDF + Word), every claim cited to a real source and verified before export, a submission guide for getting it to your payer, and the option to refine any paragraph before downloading.
Frequently asked
See all- Is this a lawyer?
- No. We help you draft a letter you sign and send yourself. For complex cases involving litigation, we recommend a healthcare attorney.
- What if my insurer denies the appeal?
- Many denials can be escalated to external review. We'll generate that letter too, when it's the right move.
- Do you store my medical records?
- No. Uploads, extracted data, and drafted letters are all automatically deleted within 24 hours — download links stay valid for 24 hours after delivery, so save your letter when you export it. See our HIPAA notice.