Facet injections, radiofrequency ablation, and epidural steroid injections carry detailed coverage rules on pain scores, imaging guidance, levels, and frequency. Missing one element in the note can sink the claim. Start with the map below before any billing handoff.
Book a demoMedicare contractors publish local coverage determinations (LCDs) for the most common spine procedures. The examples below come from two of those policies.
The facet policy cited here calls for two diagnostic procedures, each with a consistent minimum of 80% relief, before therapeutic facet injections. Therapeutic injections also need a documented reason the patient is not a candidate for radiofrequency ablation.
Policies cap how many levels are covered per session and how often procedures repeat. The epidural policy cited here covers transforaminal injections at up to two levels in one spinal region, and repeats need documented, lasting improvement.
Epidural injections must be done under CT or fluoroscopic guidance with contrast unless a documented reason rules it out. A pain or function score recorded at baseline, and repeated on the same scale, supports every later claim.
Pain practices often treat patients in the office, a surgery center, and a hospital, and each site changes who bills what.
Physicians document pain scores, conservative care history, imaging guidance, and levels treated. They approve the codes Taiga drafts before submission.
Taiga checks eligibility, scrubs claims against payer rules, submits them, and works each denial and appeal to the end. Patient statements and follow-up are included.
Commercial prior authorizations, facility claims for a procedure suite or surgery center you own, and medication management visits each need a clear owner.
Bring de-identified notes for a diagnostic block, a radiofrequency ablation, and an epidural injection.
List office, surgery center, and hospital sites, and who sends the facility claim for each.
Show where pain scales, relief percentages, and conservative care history appear in your templates.
Summarize recent denial reasons, especially frequency, level, and medical necessity denials.
Useful for a physician-owned interventional pain practice that wants procedure claims and appeals worked closely, with physicians keeping the final say on codes.
Interventional pain management is not on Taiga's published specialty list, so bring your service mix and Taiga will tell you straight whether it fits. LCDs differ by Medicare contractor, so check the policy for your region.
Common gaps are missing diagnostic block results, relief not measured on a consistent scale, or a repeat procedure inside the policy's frequency limits. Compare the note against the LCD your Medicare contractor publishes.
Under the epidural LCD cited on this page, transforaminal injections are covered at up to two levels in one spinal region, and interlaminar or caudal injections at one level. Other contractors' policies can differ.
If the work fits, yes. Taiga works every denial and appeal, including small-dollar ones.
No. Taiga works alongside your existing EHR and drafts codes from your procedure notes for physician approval.
Show Taiga your blocks, ablations, and injections alongside recent denials. If it fits, onboarding takes about two weeks to first claim.
System guides show possible billing handoffs, not proven specialty compatibility.