This past November, CMS announced that starting January 1, 2023, Medicare will pay physicians in all states and other practitioners with prescription authority such as Nurse Practitioners (NP’s) and Physician Assistants (PA’s) in some states, to perform comprehensive pain management for their patients living with chronic pain. Medicare health insurance covers individuals over the age of 65 and disabled Americans.
CMS has created two specialized billing codes just for chronic pain management (CPM codes G3002 and G3003) that these health care practitioners can use to get paid for their time spent caring for patients and coordinating patient care with other health care practitioners like physical therapists, psychologists and even complementary practitioners such as massage therapists and acupuncturists.
Did CMS include patient input in the ruling?
Yes! CMS released a draft version of this idea in July 2022 and posed many questions asking for patient and other stakeholder input. The U.S. Pain Foundation sent an alert this summer explaining the kinds of input they were seeking. Thank you to those who took action! U.S. Pain Foundation submitted a lengthy comment to the docket answering CMS’s questions from the patient perspective. You can read our comment here. We are pleased that CMS really did incorporate our recommendations into the final rule. In fact, they quoted the organization’s comment 12 times in the final rule.
How will this improve pain care?
People with pain have had a difficult time finding physicians that will care for them. Chronic pain is complex and many physicians are reluctant to spend the time required to find the right treatments for them. Further, doctors often lack the training to know about the full range of options available to manage chronic pain as well as the best way to assess pain and create treatment plans for patients.
CMS’s new codes require doctors to spend at least 30 minutes with the patient monthly and doctors can add an unlimited amount of time to that in 15-minute increments. CMS will pay for monthly visits if that is what is required. In addition, CMS has specified what tasks physicians must perform that comprise comprehensive pain management although they do not require that every task be performed for every patient. The tasks include diagnosis, assessment, the development and revision of a care plan and on-going communication and coordination with other necessary practitioners involved in your pain care, to name a few.
How will I know if my doctor is using this code?
CMS is requiring the physician, PA or NP to obtain the patient’s consent and document it in the record prior to billing this code for the first time.
Do the new codes allow telehealth visits with my doctor?
CMS is requiring that the initial visit with your doctor using the new codes is in person but any subsequent visits may be conducted using telehealth.
What about if I have already been seeing a doctor for pain management and have an on-going treatment plan?
CMS is not requiring that every task be completed with every patient. They have stated that they do not expect that every element of the code will be appropriate for every patient. The new codes do include revision and maintenance of the care plan so these ongoing visits should be covered.
Will any doctor regardless of specialty be able to bill these new CPM (chronic pain management) codes?
Yes. The codes can be used by any licensed physician including primary care providers, pain management specialists, physiatrists, neurologists and many other physician specialties who treat individuals living with chronic pain.
Will other public and private insurers cover monthly chronic pain management visits?
These codes and this coverage decision only applies to Medicare beneficiaries. However, private insurers often follow Medicare’s lead so they may decide to offer similar coverage in the future.
Should I mention this to my doctor?
Yes. We recommend that you do mention it in case your doctor does not know about this new form of payment for chronic pain management visits by patients with Medicare coverage.