Pain management practices face a 14.7% denial rate — driven by prior auth for injections, opioid prescribing scrutiny, UDS billing complexity, and fluoroscopy guidance coding.
Common Billing Challenges
These are the six billing failure points we see most often — and the ones our team resolves systematically from day one.
Epidural steroid injections, nerve blocks, and spinal cord stimulator procedures require prior authorization from nearly every commercial payer. We submit auth requests with full clinical documentation before every procedure day.
Injection procedures performed under fluoroscopic guidance (77003) or CT guidance (77012) are separately billable — but only with the correct imaging documentation in the procedure note. Missing this code costs $80-120 per procedure.
Urine drug screening in pain management involves two separate billing events: the presumptive screen (G0481-G0483 or 80305-80307) and the definitive confirmation (80320-80377). Incorrect level selection causes systematic denials.
SCS trial, implant, and programming codes are among the most complex in pain management — requiring correct distinction between trial (63650) and permanent implant (63685), plus programming codes (95972) at each follow-up.
OTP billing uses bundled weekly rates (HCPCS H0020) for methadone maintenance, with add-on codes for counseling and toxicology. CMS OTP certification status directly affects billing eligibility.
When injections are performed bilaterally in the same session, modifier 50 applies for some codes while separate line items (LT/RT) are required for others — depending on the payer and the specific CPT code.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in that specialty.
| CPT Code | Description | Common Issue |
|---|---|---|
| 62323 | Epidural injection, lumbar/sacral | Clinical documentation package |
| 64483 | Transforaminal epidural, lumbar/sacral | 77003 add-on, imaging note required |
| 77003 | Fluoroscopic guidance for injection | Presumptive vs. definitive level |
| 62310 | Epidural injection, cervical/thoracic | Trial vs. permanent distinction |
| 64635 | Ablation, nerves innervating sacroiliac joint | OTP certification required |
| 95972 | SCS programming, complex | Modifier 50 vs. LT/RT by payer |
Why RCMAXIS
We are not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to your field — not a generic CPC only.
Significantly above the 14.7% industry denial rate for your specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.