Federal IDR · Code overview
Out of network Facet joint radiofrequency ablation, lumbar or sacral, single (CPT 64635) denied?The denial, the code, and the path to recovery.
Out of network Facet joint radiofrequency ablation, lumbar or sacral, single (CPT 64635) is routinely paid below the billed charge or denied outright. That gap is what federal independent dispute resolution exists to recover. We prepare the submission and you keep the recovery.
CPT 64635 covers heat lesioning of the nerve to a low back facet joint at one level.
Why claims like this get denied.
Out of network Facet joint radiofrequency ablation, lumbar or sacral, single claims in any state are commonly underpaid or denied for reasons like these.
Frequency or level limit applied
A frequency or level limit was applied to the injection series, denying covered levels.
Denied as not medically necessary
The claim was denied as not medically necessary, common on interventional pain procedures where the payer second guesses the indication.
Anchored to the qualifying payment amount
The payer priced the claim off the qualifying payment amount, which often sits well below the real market rate for Facet joint radiofrequency ablation, lumbar or sacral, single.
Modifier or documentation gap
A modifier or documentation gap let the payer downcode or deny rather than pay the level billed.
We do this for you.
When an out of network surgical claim is filed right, federal IDR routinely pays well above the insurer's first number, and most properly filed disputes go the provider's way. We build the submission, your billing team approves it, and you keep the recovery. We do this every day and we win most of the time. No one can promise a specific result on a specific claim, and we will not pretend otherwise.
No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. Any general figures reflect the published federal record across all disputes, not a prediction about your claim. This is general information, not legal or financial advice.
The window does not wait.
Most practices never file, and the window does not wait. After open negotiation ends you have four business days to start a dispute. Miss it and that money is gone for good. This is the part that costs surgical practices the most, doing nothing.
Send us this denial.
Send us this denial. We will tell you fast whether it qualifies and, if it does, we build the submission.