ClaimCarePro

Pain Management Billing Services

ClaimCarePro provides pain management billing services for interventional pain practices: epidural and facet injection coding with the right units and bilateral modifiers, radiofrequency ablation billed to Medicare's coverage rules, frequency tracking by spinal region, prior authorization, drug and urine-testing lines, and workers' compensation and Florida PIP cases. Full-service billing is 6% of collections with a $1,000/month minimum, month-to-month, no setup fee. Family-owned in Clearwater, Florida, billing since 2010.

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What our pain management billing services include

Epidural steroid injection coding

Interlaminar injections (62321, 62323), transforaminal injections by region (64479–64480 cervical/thoracic, 64483–64484 lumbar/sacral) and caudal injections coded per level and side. The imaging guidance is part of these codes, so fluoroscopy (77003) is not billed on top. Additional transforaminal levels are add-on units, and bilateral work carries modifier 50 or LT/RT as the payer requires.

Facet blocks and radiofrequency ablation

Medial branch blocks and facet injections (64490–64495) and radiofrequency ablation (64633–64636) billed in the order the coverage policy expects: two diagnostic blocks, each documenting at least 80% relief of the index pain, before the first ablation; one or two levels per session; no more than two ablation sessions per region in a rolling 12 months.

Prior authorization and frequency tracking

Authorization requested before the procedure is scheduled, with the conservative-care history, imaging and pain scores the plan asks for. Each patient's injection count is tracked by spinal region against the payer's limit — four epidural sessions per region per rolling 12 months under Medicare's policy — so a session over the limit is caught before it is performed.

Spinal cord stimulators and advanced procedures

Trial and permanent neurostimulator placement, programming visits, peripheral nerve blocks, joint and trigger point injections, and the device and drug lines that go with them — with the global period of each implant code tracked so the follow-up visits are billed correctly.

Drugs, wastage and urine drug testing

Injected steroids and other drugs billed by HCPCS J-code units, with JW for discarded drug and JZ when none is discarded from a single-dose vial. Presumptive (80305–80307) and definitive (G0480–G0483) drug testing billed at the frequency and documentation level each payer pays.

E/M visits on procedure days

An office visit on the same day as an injection is billed only when it is a separately identifiable service, with modifier 25 and documentation that shows it. Medication management, new complaints and decision-making for a different region are where that line is drawn.

Workers' compensation and auto injury

Work injuries billed to the carrier under the state workers' compensation fee schedule, and Florida auto injuries billed under PIP, MedPay and the health plan in the right order, with the letters of protection and lien balances tracked separately from insurance A/R.

Credentialing for pain physicians and ASCs

Medicare, Florida Medicaid, managed care and commercial enrollment for physicians, nurse practitioners and physician assistants, by the team that bills the claims. A flat $250 per payer application, or the $1,750 new-practice bundle per provider.

Why pain management claims deny — and how we prevent it

Fluoroscopy billed on top of a code that includes it

Epidural and facet codes include imaging guidance in their descriptors. Adding 77003 or a CT guidance code to the same line is an unbundling edit, and repeated across a year it is the kind of pattern an audit samples.

Units and sides on add-on levels

Each additional transforaminal or facet level is an add-on code with its own units. Bilateral work is modifier 50 for some payers and LT/RT on separate lines for others. Getting it wrong underpays the claim or bills a level twice.

Frequency limits by spinal region

Medicare's epidural policy allows four sessions per spinal region in a rolling 12 months, with transforaminal injections limited to two levels and interlaminar and caudal injections to one. Facet ablation is limited to two sessions per region per rolling 12 months. Sessions past the limit deny.

Ablation without two qualifying diagnostic blocks

Medicare covers the first radiofrequency ablation only after two diagnostic medial branch blocks, each with at least 80% relief of the index pain documented for the expected duration of the anesthetic. A missing pain diary or a block with less relief makes the ablation non-covered.

Image guidance that the policy does not accept

Medicare's facet policy treats procedures done without CT or fluoroscopic guidance, including ultrasound- or MRI-guided ones, as not reasonable and necessary. Epidurals need CT or fluoroscopy with contrast unless the record documents why contrast was not used.

Anesthesia during spine procedures

Monitored anesthesia or sedation during routine epidural and facet procedures is a CMS Recovery Audit topic. When it is billed, the record has to show why the patient needed it.

The office visit on injection day

A visit to decide on and consent for a scheduled injection is part of the procedure. Billing it with modifier 25 needs a separately identifiable problem in the note, or the visit is denied — or paid and later recouped.

Prior authorization that expires

Commercial and Medicare Advantage authorizations are issued for a code, a level count, a date range and sometimes a site. A procedure that adds a level, moves to another facility or slips past the end date bills without an authorization.

Pain management billing cost: in-house vs outsourced

What outsourced pain management billing costs here

Full-service pain management billing is 6% of collections with a $1,000 monthly minimum, month-to-month, no setup fee. Aged or denied claims are worked on a 10% contingency, paid only from what is recovered. The price is on our pricing page, not quoted after a sales call.

What in-house pain management billing costs

An in-house team is salaries, benefits, coding training, software and clearinghouse fees, plus an authorization coordinator, paid whether claims pay or not. A percentage fee moves with deposits.

Where in-house pain billing usually loses money

On the frequency limit nobody tracked, the ablation billed after one diagnostic block, the expired authorization, the bilateral add-on level billed once instead of twice, and the denial nobody had time to appeal.

Do they know the coverage policies by heart?

Ask any pain management billing company how many epidural sessions per region Medicare allows, what has to be documented before a first ablation, and how it bills a bilateral add-on level. A specific answer is a better sign than a logo list.

Will they sign a BAA, and can you leave?

Any company handling your patients' claims should sign a Business Associate Agreement before it sees a record. ClaimCarePro signs a BAA and bills month-to-month with no setup fee and no exit fee.

Who is behind the work?

ClaimCarePro is a family-owned billing company in Clearwater, Florida, billing since 2010, with 30+ years combined billing experience, a bench of experienced part-time billers scaled onto accounts as needed, and AI automation that checks each claim before it goes out.

How we take over your pain management billing

  1. 1

    Free coding and A/R review

    We review 90 days of claims, operative notes and remittances for unbundled imaging, unit and side errors, frequency-limit denials, ablations without qualifying blocks and expired authorizations.

  2. 2

    Recover the aged and denied claims

    Under-billed levels corrected, denials appealed with the pain diaries and imaging the policy asks for, and PIP and workers' compensation balances followed up, on a 10% contingency.

  3. 3

    Map procedures, payers and sites

    Each procedure mapped to its codes, modifiers and payer policy; each payer's authorization list loaded; office, ASC and hospital sites set up with the right place of service.

  4. 4

    Authorization and frequency checks before the procedure

    Authorization confirmed for the code, level count and site; the patient's session count by region checked; diagnostic-block relief documented before an ablation is scheduled.

  5. 5

    Coding, posting and follow-up

    Operative notes coded the day they are signed, ERAs posted, denials worked by cause, and a monthly report by physician, procedure and payer.

  6. 6

    Credentialing kept current

    New physicians and APPs enrolled before their first procedure day, ASC and hospital privileges tracked, and revalidations filed before a lapse.

Pain management billing services: questions buyers ask

How much do pain management billing services cost?
Most pain management billing companies charge a percentage of collections. ClaimCarePro charges 6% of collections with a $1,000 monthly minimum, month-to-month, with no setup fee. Aged or denied claims are worked on a 10% contingency. Credentialing is a flat $250 per payer application, or $1,750 per provider for the new-practice bundle.
Is outsourcing pain management billing cheaper than in-house?
It depends on volume and on what in-house billing is missing. In-house billing is salaries, benefits, coding training, software and an authorization coordinator, paid whether claims pay or not. An outsourced fee rises and falls with collections. The bigger number is usually what frequency-limit denials, unbundled imaging and expired authorizations are costing today.
Can fluoroscopy be billed with an epidural steroid injection?
Not separately for the codes that include it. The epidural codes 62321 and 62323 and the transforaminal codes 64479 through 64484 include imaging guidance in their descriptors, so 77003 is not added. Facet codes 64490 through 64495 also include guidance. Billing it on top triggers an unbundling edit.
How are 64483 and 64484 billed?
64483 is the first lumbar or sacral transforaminal level and 64484 is each additional level, billed as add-on units. For bilateral work, many payers want modifier 50 on each code; others want separate LT and RT lines. Medicare's epidural policy covers transforaminal injections at no more than two levels in one region per session.
How many epidural steroid injections will Medicare pay for?
Medicare's epidural steroid injection policy allows up to four sessions per spinal region in a rolling 12-month period. Transforaminal injections are limited to two levels per session, and interlaminar and caudal injections to one level, not bilateral. Injections must be done under CT or fluoroscopy with contrast unless the record explains why not.
What does Medicare require before radiofrequency ablation?
Two diagnostic medial branch blocks, each producing at least 80% relief of the primary pain for the expected duration of the anesthetic. Ablation is covered at one or two levels per session, no more than two sessions per spinal region in a rolling 12 months, and only under CT or fluoroscopic guidance.
Can I bill an office visit on the same day as an injection?
Only when the visit is a separately identifiable service, such as managing medications or evaluating a new problem, documented separately and billed with modifier 25. The visit that decides on and consents for a planned injection is part of the procedure. Billing it anyway is denied or recouped later.
Do you bill workers' compensation and auto-injury pain cases?
Yes. Work injuries are billed to the carrier under the state workers' compensation fee schedule and reporting rules. Florida auto injuries are billed under PIP first, then MedPay and the health plan, with letters of protection and settlement liens tracked separately from insurance balances.
Why do pain management claims get denied?
The common causes are frequency limits by spinal region, missing or expired prior authorization, ablations without two qualifying diagnostic blocks, imaging guidance billed separately, wrong units or bilateral modifiers on add-on levels, and E/M visits with modifier 25 the note does not support. Each can be checked before the claim is sent.
How do you switch pain management billing companies?
Give notice under your current contract, keep access to the billing system through the run-out, and pull an aging report and the open authorization list. A typical switch takes two to four weeks: review, payer and procedure mapping, then new claims, with old claims worked in parallel.

See what your pain management A/R is actually worth

Last updated October 29, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro. Send us 90 days of claims and operative notes and we will show you the under-billed levels, the frequency and authorization denials and the ablation claims that can still be corrected or appealed. Billing is 6% of collections, month-to-month, no setup fee.

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Related resources

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Credentialing services

Published pricing for Medicare, Florida Medicaid, managed care and commercial network enrollment.

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Orthopedic billing services

Joint injections, global surgery and fracture care for practices that share spine and joint patients.

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Personal injury (Florida PIP) billing

The 14-day rule, the PIP benefit and the order PIP, MedPay and the health plan pay in.

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Prior authorization delays

Keeping authorization rules from stalling procedure claims.

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