Medical Necessity Template Letters

Download Support Tools

Sometimes, third-party payers require pre-authorization, or a denied claim may need to be appealed with information about the clinical basis for orthotics prescription. These support tools are editable template letters with suggested content to use when submitting this information. Download, review and save these documents for future use. NOTE: Once you click on the resource, look for the document in your downloads or taskbar. Unlike a PDF, these will not open up on your desktop.

Sample Letter of Medical Necessity for Custom Functional Orthotics
Letter of Medical Necessity and Pre-Authorization for Functional Orthotics-Template