Pain management lives or dies on prior authorization.
Injection series are approved in blocks, capped per year and reviewed constantly. The procedure is the easy part; keeping the authorization ahead of the schedule is the work.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Pain Management claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Authorization expires mid series
Approvals cover a window and a count. When the schedule slips past either, the next injection is unfunded and the patient is already in the room.
- Series limits exceeded
Most payers cap injections per region per year. Beyond the cap it is a write off, and the cap is easy to lose track of across providers.
- Fluoroscopy and guidance billed separately when bundled
Imaging guidance is bundled into many injection codes. Billing it separately triggers edits and, repeated, an audit.
What we bill for Pain Management practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Pain Management accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A pain management coder, not a general one
The coder assigned to your account works pain management every day. They already know which of your payers do what, and they are watching authorization windows, injection series limits and fluoroscopy bundling.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in pain management it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your pain management claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Pain Management practices
- Coders who work pain management daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Pain Management billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Pain Management service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Pain Management practices ask
Do you manage the authorizations?
Yes, and we track the window and the remaining count so the schedule does not outrun the approval.
How do you handle drug testing?
Carefully. Frequency and medical necessity are heavily scrutinised, and volume without documentation is the fastest route to an audit.
Can you track annual injection limits?
Yes, per region and per payer.
What about stimulator trials?
Trial and permanent implant are separate approvals and separate claims. Both are tracked.
Have a pain management coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.