Since the inception of electric discharge machining (EDM), it has facilitated the production industries, for instance, die & mold, automotive, aerospace, etc., by providing an effective solution for machining hard-to-cut materials and intricate geometries. However, achieving high machining rates and a fine surface finish is an inherent issue with the traditional EDM process. The emergence of the powder mixed electric discharge machining (PMEDM) process has not only provided the opportunity for enhancing productivity and surface finish but also opened a window for its potential application in surface modification/coating of biomaterials. The process incorporates simultaneous machining and coating of bioimplants, i.e., lacking in the already available chemical and physical coating methods while requiring costly post-treatment procedures. This study comprehends the influence of powder characteristics and EDM process parameters on the performance parameters. The impact of tool electrodes and additive powders on the machined and coated surface of commonly used biomaterials. Furthermore, the study depicts the most frequently used methods for optimizing the PMEDM process, future research directions, challenges, and research trends over the past decade. © 2023 by the authors.