CMS introduced new CPT codes for Chronic Pain Management (CPM) services in the 2023 Medicare Physician Fee Schedule Final Rule as part of its ongoing effort to expand access to evidence-based treatments for acute and chronic pain and to improve the care experience for individuals suffering from pain.
The new CPM bundled payment includes elements like diagnosis, a person-centered care plan, care coordination, medication management, and other aspects of pain management. These services will be available to patients who have had persistent or recurring pain for more than three months. The new codes allow providers to modify how services are delivered based on individual patient needs.
Code Descriptors for the Pain Management CPT Codes 2023
Chronic pain management and treatment, a monthly package that includes diagnosis, assessment, and monitoring; administration of a validated pain rating scale or tool; development, implementation, revision, and/or 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; e.g. As appropriate, physical and occupational therapy, complementary and integrative approaches, and community-based care are used. A physician or other qualified health professional must provide an initial face-to-face visit of at least 30 minutes per calendar month.
When using G3002, the time limit of 30 minutes must be met or exceeded.
Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional per calendar month. (List separately, in addition to the code for G3002). When using G3003, the time limit of 15 minutes must be met or exceeded.)
HCPCS Code G3002 and HCPCS Code G3003 Billing Requirements
Billing for these codes must be in accordance with the service described in the code descriptors. CMS also finalized the following additional billing guidelines and requirements:
- The initial visit must be conducted in person, face-to-face, by a physician or other qualified health care professional (QHP), for at least 30 minutes, in a clinical setting, with both the physician or QHP and the patient. Following the initial visit, as applicable and clinically appropriate, the in-person components included in the codes may be provided via telehealth. Furthermore, certain components of the proposed bundle, such as care planning or coordination with other health professionals, would not necessitate face-to-face care.
- G3002 may be billed for a beneficiary for a month by an unlimited number of physicians or other qualified healthcare professionals as medically necessary. G3003 may be billed as many times as medically necessary for a given beneficiary and a month after G3002 has been billed. CMS, on the other hand, will keep track of utilization.
- Beneficiary consent must be given verbally during the initial visit and documented in the beneficiary's medical record. Beneficiaries should be educated on what CPM services are, how frequently they can expect to receive them, and what cost-sharing may apply in their specific situation.
- Alternate personnel may not provide services in connection with a physician's professional services.
- If all reporting requirements for each service are met, CPM services may be billed on the same date as evaluation and management (E/M) services, or in the same month as remote physiologic monitoring (RPM), remote therapeutic monitoring (RTM), and care management services such as chronic care management (CCM), transitional care management (TCM), or behavioral health integration (BHI). Time spent providing CPM services, on the other hand, cannot be used to represent time spent on any other provided and billed service.
- CPM services are only available in the office or in other outpatient or domiciliary settings.
CMS took the initiative to develop a new code set to reimburse for the management of pain patients. This could be a sign of things to come, as CMS recognizes the value of care management services in improving patient outcomes and lowering overall healthcare costs.
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