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Description: The pain of Black Americans is systematically under-diagnosed and under-treated, compared to the pain of their White counterparts. Extensive research has examined the psychological factors that might account for such biases, including status judgments, racial prejudice, and stereotypes about biological differences between Blacks and Whites. Across seven experiments (N = 1000) we accumulated evidence that lower-level perceptual processes also uniquely contribute to downstream racial biases in pain recognition. We repeatedly observed that White participants showed more stringent thresholds for perceiving pain on Black faces, compared to White faces. A tendency to see painful expressions on Black faces less readily arose, in part, from a disruption in configural processing associated with other-race faces. Subsequent analyses revealed that this racial bias in pain perception could not be easily attributed to stimulus features (e.g., color, luminance, or contrast), subjective evaluations related to pain tolerance and experience (e.g., masculinity, dominance, etc.), or objective differences in face structure and expression intensity between Black and White faces. Finally, we observed that racial biases in perception were associated with biases in pain treatment decisions, and that this relationship existed over and above biased judgments of status and strength, explicit racial bias, and endorsement of false beliefs regarding biological differences. A meta-analysis across the seven experiments confirmed the robustness and size of these effects. This research establishes a subtle, albeit influential, perceptual pathway to intergroup bias in pain care and treatment. Implications for racial bias, face perception, and medical treatment are discussed.