Pain Management Medical Billing Services - Compare Quotes From Vetted Providers

Orders, indications, and conservative care

• Document the pain generator, duration, severity, and functional limits.
• Show failed conservative therapy when required, such as PT, NSAIDs, or prior injections.
• Link each procedure to imaging findings and a specific diagnosis.

Imaging guidance is often required

• Fluoroscopy or ultrasound guidance is integral to many injections. Bill separately only when CPT allows and the report shows needle placement, contrast spread when applicable, and final image capture.
• For ultrasound, document structures visualized and real-time guidance.

Spine injections and diagnostic blocks

• For epidural steroid injections, capture approach (interlaminar, transforaminal, caudal), level, and laterality when relevant, with contrast confirmation if used.
• For facet and medial branch blocks, list each level, side, and whether unilateral or bilateral. Use add-on units correctly and avoid unbundling when bilateral codes exist.
• Diagnostic blocks must clearly state intent, anesthetic used, immediate pain relief percentage, and duration to support subsequent RFA.

Radiofrequency ablation (RFA)

• Document target nerves, side, lesion parameters, and temperature or pulse settings.
• Confirm that prior diagnostic blocks met payer criteria before ablation and that laterality and levels match the op note.

Peripheral joint and soft tissue injections

• Record joint, tendon sheath, or bursa, laterality, and drug administered with dose and lot.
• Distinguish therapeutic injection from aspiration when both occur.

Spinal cord stimulation and intrathecal pumps

• For trials, capture lead type, vertebral level, and patient response with percent improvement.
• For permanent implants, record generator type, lead count, anchoring, and programming.
• Pump refills and programming require drug name, concentration, volumes in and out, new rate, and physician analysis time.

Urine drug testing (UDT)

• Use presumptive testing codes for qualitative screens and definitive codes or Medicare G-codes for quantitative confirmation by analyte.
• Units and tiers must match analytes tested. Document medical necessity based on risk level and treatment plan.
• Avoid duplicate billing by coordinating with the reference lab on which entity bills.

Opioid and medication management

• Capture PDMP checks, risk assessments, treatment agreements, and counseling on risks and alternatives.
• Time-based counseling or care management must meet thresholds and list activities performed.

Physical medicine and behavioral health integration

• For PT, OT, or cognitive behavioral therapy associated with chronic pain, ensure separate orders, documentation, and time.
• Avoid same-day conflicts with incident-to rules and supervision requirements in independent centers.

Modifiers that matter

• 50 for bilateral procedures when a single code covers both sides.
• RT and LT for side specificity when required.
• 25 for a significant and separately identifiable E/M on the same day as a minor procedure.
• 59 or X modifiers for distinct, non-overlapping injections or separate anatomic regions when edits bundle services.
• 52 for reduced services and 53 for discontinued procedures with clear rationale.
• 26 and TC for split professional and technical components in diagnostic testing when applicable.

Prior authorization and site-of-care rules

• Many payers require prior authorization for spinal injections, RFA, SCS trials and implants, intrathecal pumps, and advanced imaging.
• Verify steerage rules for MRI and ASC vs hospital outpatient to avoid denials.

Documentation and medical necessity essentials

• Match diagnosis to pain generator and technique.
• Include pain scores before and after diagnostic blocks and procedures.
• Record units, drugs, lot numbers, wastage when required, and start/stop times for time-based services.

Frequent denial patterns in pain management

• Missing laterality or incorrect bilateral coding
• Imaging guidance billed when bundled or documentation does not show real-time guidance
• RFA without qualifying diagnostic block history in the chart
• Epidural level or approach not documented
• UDT units or tiers that do not match analytes tested
• Prior authorization missing for procedures or implants
• E/M and procedure on the same day without a supported modifier 25

Keeping billing in-house can work well when you have a stable team, predictable volume, and the capacity to hire, train, and cover vacations or turnover. You retain tight control over workflows but you also carry the risk and cost of staffing, QA, software, and performance management.

Outsourcing shifts those burdens to a specialized team that brings SLAs, denial management, and scalable capacity. It’s often a fit when claim volume is growing, denials are creeping up, or leadership wants to redeploy staff to patient-facing work without sacrificing cash flow.