Pain management billing
Pain management billing services
We handle billing for interventional pain and pain management practices: spinal injections, nerve blocks, radiofrequency ablation, drug testing and office visits. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Injections coded by level, side and approach
- Prior authorization and coverage policy checks
- Drug testing billed by payer rules
Why pain management billing is different
Every injection is tied to a policy, a level and a side
Pain management billing is different because most procedures are covered only under detailed payer policies that set prior tests, frequency limits and documentation rules. A clean claim starts before the procedure.
Levels, sides and add-ons
Facet injections and transforaminal epidurals are coded per level, with add-on codes for extra levels and modifier 50 or RT/LT for sides. Getting the count wrong is one of the fastest ways to lose payment.
Imaging guidance is often included
Many spinal injection codes include fluoroscopic or CT guidance, so it cannot be billed separately. Other injections allow separate guidance codes. We check each code pair.
Coverage policies for facets and RFA
Medicare local coverage policies for facet interventions generally expect diagnostic medial branch blocks with documented relief before radiofrequency ablation, and limit how often each is repeated.
Prior authorization
Epidurals, RF ablation, spinal cord stimulator trials and many other procedures need prior authorization with commercial and Medicare Advantage plans. We confirm it is on file before the claim goes out.
Urine drug testing
Presumptive tests (80305 to 80307) and definitive tests (G0480 to G0483 for Medicare, 80320 to 80377 for many others) have different medical necessity and frequency rules. Standing orders for definitive testing are a common audit target.
Place of service
Procedures done in an office, an ambulatory surgery center or a hospital outpatient department are billed with different places of service and paid at different rates. The POS has to match where the work was done.
Common codes
Pain management codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 62321 / 62323 | Interlaminar epidural injection, cervical/thoracic or lumbar/sacral, with imaging | Imaging included; frequency limits; authorization |
| 64483 / +64484 | Transforaminal epidural, lumbar or sacral, first and additional levels | Levels and sides match the note; guidance included |
| 64490–64495 | Facet joint or medial branch injections by region and level | Per-level add-ons; modifier 50 for bilateral; coverage policy |
| 64633–64636 | Radiofrequency ablation of facet nerves | Prior diagnostic blocks documented; repeat-interval limits |
| 27096 | Sacroiliac joint injection with imaging | Imaging required; laterality; payer coverage varies |
| 80305–80307 | Presumptive urine drug testing | One per date of service; medical necessity |
| G0480–G0483 | Definitive drug testing (Medicare), by number of drug classes | Individual order and reason documented; frequency |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Pain management denials we stop before they happen
Most pain management denials are about policy requirements, not coding errors. We check the policy before the claim is filed.
- Procedures performed without an active prior authorization
- RF ablation billed without documented diagnostic blocks
- Injections repeated sooner than the payer’s frequency limit
- Wrong number of levels, or missing modifier 50 or RT/LT
- Imaging guidance billed separately when it is included in the code
- Definitive drug testing without an individual order and reason
- Place of service that does not match where the procedure was done
What we handle
Everything between the visit and the payment
Our core focus is behavioral health, and we bill pain management with the same team, the same promises and CPB-certified billers on the team.
- Insurance eligibility, benefits and authorization checks before procedures
- Charge entry and coding review of levels, modifiers and drug tests
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Credentialing and payer enrollment for new providers
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Pricing
Clear pricing for pain management practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing.
Common questions
Can we bill fluoroscopy separately with an epidural or facet injection?
Usually not. Codes such as 62321, 62323, 64483 and 64490 to 64495 include imaging guidance. Some other injections allow a separate guidance code, and we check each one.
How do you bill bilateral facet injections?
Most payers want the procedure billed with modifier 50, while some want RT and LT on separate lines. We follow each payer’s format and count levels from the procedure note.
What do payers need before RF ablation?
Many policies, including Medicare local coverage policies, generally expect diagnostic medial branch blocks with documented pain relief first, plus limits on how often ablation is repeated. Rules vary by payer; we check current policy.
Do you bill urine drug testing?
Yes. We bill presumptive and definitive tests under each payer’s rules and check that definitive tests have an individual order and documented reason.
Do you handle prior authorizations?
We check whether each procedure needs an authorization and confirm it is valid before billing. Requests can be submitted by your team or by an optional RevenueCTRL virtual assistant.
Is there a long-term contract?
No. There is no setup fee and no long-term contract. Terms are flexible.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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