CMS explained their proposal in the recently released draft Medicare Physician Fee Schedule (PFS) for 2023 and are seeking comments on this proposal by September 6, 2022. This message is a follow-up to our earlier message alerting you to this development. We said that we would get back to you with a call to action and this message will explain actions that you can take prior to 5pm on September 6th when the comment period ends.
What does CMS plan to do that will benefit chronic pain patients who are on Medicare?
Why is this important and when would it start?
U.S. Pain Foundation believes this is an important, positive step forward for millions of Americans living with chronic pain. Americans over the age of 65 and those younger than 65 who are disabled and receive health coverage through Medicare would be eligible for this benefit starting January 1, 2023. Private health insurers tend to follow CMS’s lead so we would expect that private insurers would begin to provide similar benefits.
Is there anything else I should know?
CMS has asked for feedback on a number of questions they have about the use of these new CPM codes. We have selected some of the most important questions for patients to answer, if you choose to do so. They are:
- Duration of physician visits?
CMS has proposed 30 minutes for each monthly appointment with the ability to add on 15 minutes per month. CMS wants to know if you think they should allow for more time and suggested 45 minutes or an hour monthly for physician visits, with the ability to add on 20 minutes more per month.
- Newly diagnosed vs long time chronic pain patient?
Should CMS allow the same amount of time for physician visits when a patient is first diagnosed with chronic pain in that visit as they do for a person who has lived with chronic pain for a long time and is seeing a new physician?
- Face-to-face vs telehealth?
CMS has proposed that the first visit with a new physician should be in person and subsequent visits would be allowed by telehealth as an option. They want to know what you think. Should all visits be allowed to use telehealth or should they be required to be in person?
- Patient’s consent?
Should physicians be required to get the patient’s verbal consent before using the CPM code? Use of the CPM code would mean that physicians would have to perform the services that comprise the code. CMS also would like to know if the doctor should be required to get the patient’s verbal consent on every visit or just the first visit?
CMS has also asked if specialists or therapists, such as physical therapists who the patient sees for treatment as part of the plan, should be required to get the patient’s verbal consent prior to treatment?
- Are any services missing?
The list of services that CMS has included in the proposed new CPM main code, GYYY1, include: diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling*; crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care (e.g. physical therapy).
CMS defines health literacy counseling as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.)
CMS would like to know if any other services should be included in the new CPM code or if any listed should be eliminated?
- What other providers does your doctor need to coordinate with?
CMS would like information on what other service providers, therapists or specialists your doctor will need to coordinate your care with and what that coordination involves. For example, you may be referred to a medical specialist such as a headache specialist or your doctor may recommend that you see a massage therapist, acupuncturist or yoga practitioner. That coordination may involve the exchange and review of test results or review and discussion of reports from the therapist about what progress s/he has made in improving your functioning or reducing your pain. CMS wants to know about that. CMS may want to be sure your doctor is properly compensated for time spent coordinating your care.
What Action is U.S. Pain Foundation Recommending?
We think it is important for people with chronic pain and those that care about them to write to CMS during this open comment period and tell them that you support the new Chronic Pain Management (CPM) codes they have proposed, GYYY1 and GYYY2, and want them to go ahead with this proposal starting in January, 2023.
How do I send in a comment?
Click here: CMS-2022-0113. This link will take you to the correct docket where you then need to click the “Comment” button.
To make it easier for you, U.S. Pain has drafted a comment for you to use. All you need to do is cut and paste the comment below (including the file code), date it, type your name, submit it and you are done.
You can also add to the message by answering the questions we outlined above or anything else relevant to these new codes you wish to say. It will receive more attention if you change or add to our message so they are not all the same. If you create your own message, please be sure to thank CMS for this important step in improving pain care. We are confident CMS will listen to comments and refine these codes in the coming years.
Month/day, 2022 File code: CMS-1770P
Regulations.gov docket #: CMS-2022-0113
Comment on The Centers for Medicare & Medicaid Services (CMS) Proposed Rule: CY 2023 Payment Policies under the Physician Fee Schedule (PFS)
Section 33, page 214: Chronic Pain Management and Treatment (CPM) Bundles (HCPCS GYYY1, and GYYY2)
Dear CMS Administrator:
I am a person living with chronic pain and I am writing to thank you for your decision to create separate billing codes for Chronic Pain Management. Chronic pain management is complex and requires a doctor to spend considerable time creating an individual treatment plan for each person who lives with pain. It may take trials of many different therapies and/or medications to find the right combination of treatments to help each person. Many doctors still do not understand this and those that do are often reluctant to spend the time listening to the patient and coordinating the care of different specialists and therapists until the doctor and patient together find the right multidisciplinary plan of care.
By specifying all the steps necessary to accomplish this, CMS is telling doctors that patients complaints of pain must be assessed and taken seriously and that CMS expects doctors to work with patients to develop, manage and coordinate a plan of care that will effectively manage a patient’s chronic pain. I appreciate that CMS will provide coverage for monthly visits to accomplish this.
Thank you again for taking this big step toward improving pain care for the millions of Americans who obtain their health insurance coverage through Medicare.
Read U.S. Pain Foundation's comments
Click here to read the comments U.S. Pain Foundation submitted to CMS.