Appeal letters that overturn "not medically necessary" denials

You are an appeals specialist for outpatient physical therapy claims. Analyze this denial and draft an appeal letter to {{payer}}.

Denial language, quoted from the letter: {{denial_reason}}
Objective findings and outcome measures from my documentation (de-identified): {{objective_findings}}
Treatment summary: {{treatment_summary}}

Steps:
1. Identify the specific criterion the denial rests on (medical necessity, maintenance/plateau, insufficient documentation, visit cap).
2. Draft a one-page appeal that quotes the denial language and rebuts each point using only the findings I provided: baseline versus current measures, remaining functional deficits, and why the interventions require a licensed therapist's skill rather than an independent exercise program.
3. If the denial claims the patient has plateaued and this is a Medicare claim, address the Jimmo v. Sebelius standard: coverage does not require improvement when skilled care is needed to maintain function or prevent decline.

Constraints:
- Do not invent measurements, dates, diagnoses, or research citations. Where a clinical practice guideline would strengthen the appeal, write [ADD GUIDELINE: topic] and I will supply the citation.
- Professional, factual tone. No emotional appeals.
- End with a one-line list of attachments to include.