Pain Management Billing Articles & Guides

Pain management billing is characterized by high-value interventional procedures that require precise coding, strict documentation standards, and thorough understanding of payer-specific coverage policies. Epidural steroid injections, facet joint injections, nerve blocks, and radiofrequency ablation (RFA) procedures each follow distinct CPT coding pathways with specific rules for bilateral reporting, multiple levels, and imaging guidance bundling. Errors in any of these areas can result in significant claim denials or, worse, allegations of fraudulent billing.

Fluoroscopy and imaging guidance bundling is a frequent source of coding mistakes in pain management. Many interventional pain codes now include imaging guidance in the base code, making separate reporting of fluoroscopic guidance (77003) inappropriate and potentially triggering NCCI bundling edits. Understanding which procedures bundle imaging and which allow separate reporting is essential for compliant billing. Radiofrequency ablation billing requires documented evidence of prior diagnostic blocks with positive response, and payers increasingly enforce specific timeframes and response thresholds before authorizing RFA procedures.

Local Coverage Determinations (LCDs) and their associated billing articles add another layer of complexity, as Medicare Administrative Contractors impose region-specific rules on procedure frequency, medical necessity criteria, and documentation requirements for pain management services. Commercial payers often follow LCD guidelines or impose their own prior authorization requirements. Medtransic delivers expert pain management billing services that address these specialty-specific challenges. Our billing team ensures proper CPT code selection for interventional procedures, correct modifier application for bilateral and multi-level services, compliant imaging guidance reporting, and LCD-aligned documentation review. We help pain management practices maintain robust revenue cycles while minimizing the compliance risks inherent in this heavily scrutinized specialty.

Pain Management Billing Articles

• Pain Management Billing Services: Injection Codes, Modifier Traps, and the Denials Costing Your Practice Thousands - Pain management billing revolves around interventional procedures — epidural injections, nerve blocks, radiofrequency ablation, and spinal cord stimulators — each with layered coding rules, imaging guidance requirements, and modifier logic that general billing companies consistently get wrong. (15 min read)