All BioPosture Mattresses are now made using a chemical free cotton flame barrier to comply with government regulations. Thus, no need for your Doctor to submit a Letter of Medical Necessity. BioPosture is designed to give you the healthiest sleep possible. Technology on the outside, comfort and support inside!
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Doctor's Letterhead
[Date]
BioPosture
218 East Park Avenue #606
Long Beach, NY 11561
Insurance Company
Address
City, ST 12345
Re: Mrs. Patient
ID#: 123-45-6789
Dear Insurance Company:
The purpose of this letter is to provide you with the medical necessity for supplying Mrs. Patient
with a BioPosture support matfress.
Mrs. Patient has been a patient in my office for the past 4 weeks. Although she has achieved
overall improvement of about 30% since undergoing care in my office, she continues to
complain of (low back pain, neck pain, low back stiftess). The patient related that the pain and
stiffness is present about 70% of the day and is worse at night. The pain and stiffiress can get so
bad that she cannot sleep more than 2-3 hours per night (add additional inability to perform
normal activities of daily living here).
The most recent physical eramination on (date goes here) revealed a moderate amount of
tightness and muscle spasm surrounding the (low'er thoracic and upper lumbar) paraspinal
musculature. X-rays of the patient reveal moderate to advanced disc degeneration
(osteoarthritis) at (T11-L3). The patient related that she feels better and is able to sleep through
the night better when she uses the BioPosrure support mattress.
I consider medically necessary for this patient to be equipped with the BioPosture support
mattress in order to hasten the healing process. The purpose of the mattress is to reduce pain,
decrease stiffness and to increase motion and flexibility in the patients' neck. The
BioPosture support mattress will also help the patient sleep through the night better and this in
turn will help the patient perform her normai activities of daily living.
The most appropriate HCPCS code at the present time for the BioPosture support mattress is
81399. Please see attached bill and feel free to contact me if anv further intbrmation is needed.
Sincerely,
Your Chiropractor