Medical practices have become accustomed to hearing about cuts to Medicare pay every year, so it’s always good news when Medicare begins covering a new service. Such is the case this year, now that CMS has introduced two new Medicare-specific codes covering chronic pain management.
Before you can start collecting for the newly-released chronic pain management codes, you must first grasp a few key facts.
The New Codes Took Effect Jan. 1, 2023
You can use the new chronic pain management (CPM) codes for dates of service January 1, 2023 and after. The codes are:
- G3002 (Chronic pain management and treatment, monthly bundle including, diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the 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 counseling; any necessary chronic pain related crisis care; and ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate. Required initial face-to-face visit at least 30 minutes provided by a physician or other qualified health professional; first 30 minutes personally provided by physician or other qualified health care professional, per calendar month. (when using g3002, 30 minutes must be met or exceeded)
- G3003 (Each additional 15 minutes of chronic pain management and treatment by a physician or other qualified health care professional, per calendar month…)
In terms of what Medicare will reimburse you for these services, you’ll bring in $79.02 for G3002 if you perform the service in a non-facility setting (such as your office) and $71.74 if the services take place in a facility setting (like a hospital).
For the add-on code G3003, Medicare will pay $28.76 in the non-facility setting and $24.80 in facilities. Because you’ll be reporting this code in addition to G3002, you’ll get paid for both services (the primary code and the add-on) when your CPM care exceeds the 30 minutes required to report G3002.
These Codes Are Similar to Chronic Care Management
The new chronic pain management and treatment codes are similar to the chronic care management codes you may be already using. Essentially, CPM includes all of the services you’re performing each month to help the patient manage their pain.
The CPM codes can be reported by providers outside of the pain management specialty, and are expected to be particularly useful for primary care practitioners who are focused on long-term management of their patients with chronic pain (CMS defines chronic pain as persistent, or current pain lasting longer than three months).
You Can Report CPM and E/M Codes on the Same Day
If the provider performs chronic pain management and a standard office visit on the same date, you can report both services, as long as you don’t count the time and the effort twice.
Example: An established patient presents to evaluate her hypertension, diabetes, and chronic pain. The physician spends 25 minutes on the E/M portion of the service and discussing medications and lifestyle changes related to hypertension and diabetes. She then spends 30 minutes dealing with pain management. In this case, you’d report:
- 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter; Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)
- One unit of G3002.
You Must Furnish the Required Code Elements
CMS lists the code elements for G3002 and G3003 as follows. Keep in mind that you must perform all of those that are appropriate for your patient on the particular date of service. If you didn’t perform one of these elements, you can still report the code, as long as you did everything that was medically appropriate for the patient on that date:
- Assessment and monitoring
- Administration of a validated pain rating scale or tool
- The 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 counseling
- Any necessary chronic pain related crisis care
- Ongoing communication and care coordination between relevant practitioners furnishing care, for example, physical therapy and occupational therapy, complementary and integrative approaches, and community-based care.
Earn maximum revenue this year by ensuring you know how to report all the 2023 codes properly. During the one-hour online training, “Master the 2023 CMS Fee Schedule Changes to Boost Revenue,” coding expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO will walk you through everything you need to know this year so you don’t miss out on a penny of reimbursement.
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