Prior authorization on most procedures
Injections and ablations usually require authorization, and the authorization must match the level and laterality actually performed. Mismatches deny even when the procedure was approved.
Specialties › Pain Management
Pain Management Billing Services
Interventional pain management is one of the most prior-authorization-heavy and most policy-governed specialties in medicine. Procedures are frequently limited by coverage policy — how many, how often, at which levels, and with what documented conservative care first. Practices that bill pain management like general medicine lose a large share of procedural revenue to preventable denials.
What makes it hard
Pain Management billing challenges we solve
These are the issues that repeat every month in pain management practices — and the ones we fix at the source rather than reworking claim by claim.
Frequency and coverage limits
Payers limit how often the same procedure can be repeated and often require documented response to prior injections before approving more.
Level, laterality and bilateral reporting
Spinal procedures are billed by level and side, with add-on codes for additional levels. Reporting these incorrectly either underpays the case or triggers a denial.
Conservative care documentation
Coverage typically requires documented failure of conservative treatment first. When the record does not show it, medical necessity denials follow.
Facility vs office setting
The same procedure reimburses very differently in an office, an ASC and a hospital outpatient department, and each has its own billing requirements.
Coding depth
Common code families we work with
- 64483 / 64484 — transforaminal epidural injection, lumbar/sacral with add-on levels
- 62321 / 62323 — interlaminar epidural injection with imaging guidance
- 64490–64495 — paravertebral facet joint injections by level
- 64633–64636 — radiofrequency ablation of facet joint nerves
- 20610 / 20611 — major joint injection, without and with ultrasound guidance
- 27096 — sacroiliac joint injection with imaging guidance
- 99202–99215 — office evaluation and management
Listed for context only — this is not billing advice, and payer policy varies. Our certified coders work to AAPC and AHIMA standards.
Denial prevention
Top denial drivers in pain management
- No authorization on file, or authorization does not match the procedure performed
- Frequency limit exceeded for the procedure
- Conservative treatment not documented
- Incorrect level or laterality reporting
- Imaging guidance billed separately when bundled
We root-cause denials by payer and procedure, then fix the upstream workflow so the same denial stops recurring.
Why ERG
What you get with ERG
Specialty-trained billers
Your account is worked by people who bill pain management every day — not a general pool learning your rules on your claims.
95%+ net collection rate
Relentless follow-up on every claim, with aged A/R worked rather than written off.
No long-term contract
Performance-based pricing — a percentage of what we collect. Stay because the results are good, not because you are locked in.
5–10 day onboarding
We run parallel with your current process until the transition is verifiably clean.
Human-led, AI-supported
Our certified coders work every claim; AI tools help them catch more before submission.
HIPAA-compliant throughout
Strict PHI controls, access limits and staff training across the whole workflow.
FAQ
Pain Management billing — common questions
Do you handle prior authorizations for pain procedures?
Yes. Authorization is the make-or-break workflow in this specialty. We obtain and track authorizations, and verify that the approved procedure, level and side match what is scheduled before the case is billed.
Can you bill both office and ASC settings?
Yes. We bill professional services in the office, ASC and hospital outpatient settings, applying the correct site-of-service rules so each case reimburses at the right rate.
Do you appeal medical necessity denials?
Yes. Medical necessity is the most common denial category in interventional pain. We appeal with the supporting documentation — conservative care, prior response, imaging — rather than writing claims off.
How do you reduce repeat denials?
We root-cause denials by payer and procedure rather than reworking claims one at a time, then fix the upstream workflow so the same denial stops recurring next month.
Client results
What practices say about working with us
★★★★★They caught underpayments our last biller never flagged. That alone covered the cost of switching.
— Dr. Kevin B., Provider
★★★★★Our A/R days dropped from 58 to 31 in one quarter. First time in years I actually trust my numbers.
— Sarah M., Practice Manager
Next step
See what your pain management practice is leaving uncollected
A no-obligation A/R analysis. We review your aging, denial patterns and coding mix, then show you exactly where the recoverable revenue is.
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