RPM CCM AWV
RPM CCM AWV

September is Pain Awareness Month. If you’re a Medicare beneficiary, there are ways available to assist you in safely and efficiently managing your pain.

Besides pain medications covered by Medicare’s prescription drug coverage (Part D), Medicare Part B (Medical Insurance) contributes to covering services that could aid in pain management, such as:physical therapy, occupational therapy, manual manipulation of the spine and behavioral health services.

These services are designed to assist in pain management while carrying fewer long-term risks compared to prescription medications like opioids.

Effective Chronic Pain Management Through Bundled Care

Guide to Effective Chronic Pain Management

The Centers for Medicare and Medicaid Services (CMS) have officially approved the coverage and payment structure for newly introduced bundled payment codes for Chronic Pain Management (CPM), starting from January 1, 2023.

This coverage signifies CMS’s commitment to enhancing the quality of care provided to individuals dealing with chronic pain. 

Additionally, it aims to better account for the time and resources dedicated to delivering comprehensive CPM services.

New CMS Codes for Chronic Pain Management

The 2023 CMS codes encompass a comprehensive range of services delivered by pain-treating physicians to a patient each month.

Instead of billing separately for these services, specialists can now utilize a bundled code on a monthly basis, simplifying the process of reimbursement for the provided care. These CMS codes for the year 2023 delineate a comprehensive array of services that pain-treating physicians furnish to patients on a monthly basis. Instead of separately invoicing each service, specialists now have the choice to utilize a bundled code, streamlining the payment collection process for the care they administer.

It is crucial to review the code descriptor to gain a precise understanding of what the CPM bundle includes.

Specifically, the code articulates the following:

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 care 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.)

To put it simply, this code covers activities such as evaluating, diagnosing, and overseeing the patient’s pain, which may involve collaborating with other health care professionals to enhance treatment and achieve improved results.

It is crucial to note, though, that this code specifically covers the initial 30 minutes of CPM services. Health care providers who spend over 30 minutes with the patient can bill for the new add-on code, as outlined below:

G3003: Each additional 15 minutes of CPM and treatment by a physician or other qualified health care professional, per calendar month. (List separately in addition to code for G3002. when using G3003, 15 minutes must be met or exceeded.) As G3003 is classified as an add-on code, health care providers are permitted to bill for it solely when they devote more than the allocated 30 minutes to CPM services.

A Case in Point to Demonstrate Use of Both Codes

Point to Demonstrate Use of Both Codes

Suppose, a returning patient attends his/her monthly pain appointment, which extends for a duration of an hour, that is 60 minutes.

If the medical records substantiate the components outlined in the code descriptors mentioned in the prior sections, the health care provider should bill for one unit of G3002 and two units of G3003.

It is worth mentioning that while CMS originally intended to restrict providers to reporting only one unit of G3003 per month, this approach has been revised.

Clinicians are now allowed to report G3003 an unlimited number of times within a month to account for every 15 minutes of CPM care that goes beyond the initial 30 minutes defined in G3002.

Additional Guidelines for Effectively Managing Chronic Care Through These Codes

CMS has also established the subsequent additional guidelines and prerequisites for billing. The initial visit must be conducted in person, face-to-face, by either a physician or Other qualified health care professional (QHP).

This encounter should last for a minimum of 30 minutes and must take place in a clinical setting.

After the initial visit, the in-person elements associated with the codes can be provided via telehealth, where relevant and clinically appropriate.

Some aspects of the proposed bundle, such as care planning or coordination with other health care professionals, may not necessarily require in-person care.

Auxiliary personnel cannot deliver these services incidentally to a physician’s (or other QHP’s) professional services.

Verbal consent from the beneficiary must be obtained during the initial visit and should be documented in the beneficiary’s medical record.

Beneficiaries should receive information regarding the nature of CPM services, their expected frequency, and potential cost-sharing based on their specific circumstances.

Concurrent Billing Allowed with These Other Forms of Chronic/ Remote Care

CPM services can be billed on the same day as evaluation and management (E/M) services or within the same month as remote physiologic monitoring services, remote therapeutic monitoring services, and care management services such as chronic care management, transitional care management, or behavioral health integration services, provided that all the requirements for reporting each service are met.

However, the time spent delivering CPM services should not overlap with the time attributed to any other service that is provided and billed.

Payment

In terms of Medicare reimbursement for these services, if providers administer G3002 in a non-facility setting (like your office), they are reimbursed at $79.02, while in a facility setting (such as a hospital), the reimbursement is $71.74.

For the add-on code G3003, Medicare will provide reimbursement of $28.76 in a non-facility setting and $24.80 in facilities. When both G3002 and G3003 are reported, the provider receives payment for both services (the primary code and the add-on) when the provided CPM care surpasses the required 30 minutes for reporting G3002.

Understanding Chronic Pain

Chronic pain is not just a physical sensation; it involves complex interactions between the body and the brain. Various conditions can cause chronic pain, such as fibromyalgia, arthritis, back pain, migraines, and nerve damage, among others. Consulting with a health care professional to diagnose the specific cause of the pain is essential in developing an effective management plan.

Dealing with Chronic Pain

Dealing with Chronic Pain

Chronic pain is defined as persistent pain lasting for weeks, months, or even years. While there may not be a definitive cure, there are numerous effective strategies for managing chronic pain.

G3002 and G3003 are open for reporting by health care providers beyond the pain management specialty and are expected to be particularly valuable for primary care practitioners focusing on the long-term care of patients with chronic pain, which is defined by CMS as persistent or lasting longer than three months).

Living with chronic pain can be an overwhelming and challenging experience. It can disrupt every aspect of a person’s life, affecting physical health, mental well-being, relationships, and overall quality of life

The following shows various pain management tools, helping those who suffer to regain control over their lives and find relief.

Medication and Interventional Treatments

Medications can play a crucial role in managing chronic pain, but they should be used judiciously and under a doctor’s supervision. Commonly prescribed pain medications include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and anticonvulsants.

However, it is essential to be aware of potential side effects and the risk of dependency when using opioids. Interventional treatments, such as nerve blocks, epidural injections, and spinal cord stimulation, can also provide relief for some chronic pain conditions. These treatments are usually performed by pain specialists and can help alleviate pain in specific areas or nerve pathways.

Physical Therapy

Physical therapy and regular exercise can be powerful allies in managing chronic pain. A skilled physical therapist can develop a personalized exercise program to improve strength, flexibility, and posture. Low-impact exercises like swimming, yoga, and tai chi can also be beneficial.

Physical therapy is also usually covered by most insurance so it can be a more cost effective option when compared to other treatments. Low impact exercise releases endorphins, which are natural pain relievers, and can improve mood and overall well-being.

Cognitive Behavioral Therapy (CBT)

Chronic pain can often cause psychological stress that can be difficult to deal with. CBT is a type of psychotherapy that focuses on changing negative thought patterns and behaviors. It can be particularly helpful for those dealing with chronic pain, as it can teach coping mechanisms, relaxation techniques, and stress management skills.

By reframing their perception of pain and developing healthier responses, individuals can improve their ability to manage and tolerate pain.

Lifestyle Modifications

Making lifestyle changes can significantly impact chronic pain management. Ensuring an adequate amount of sleep, maintaining a balanced diet, and managing stress are essential aspects of pain management. Avoiding smoking and limiting alcohol consumption can also contribute to overall well-being.

Support and Community

Living with chronic pain can be isolating, but finding support from others who understand can make a tremendous difference. Patients should join support groups, either in person or online, to share experiences, exchange coping strategies, and receive emotional support from those facing similar challenges. Seeking help from your friends and family can also help ease the burdens of life when experiencing chronic pain.

Help is Available Through Multiple Forms of Care, Including Bundled Pain Management.

multiple-forms-of-care

Chronic pain management is a journey that requires patience, resilience, and a multi-faceted approach. While there might not be a one-size-fits-all solution, combining various strategies can lead to improved pain management and overall well-being.

It is best to work closely with health care professionals to develop a personalized pain management plan that addresses your specific needs. Through a combination of medication, therapy, lifestyle changes, and support, individuals with chronic pain can begin to embrace life once again and find joy and fulfillment despite their condition.

The new CPM codes can be used to provide multiple types of care to the patient— many of which have been described in the prior section.

The new chronic pain management and treatment codes share similarities with the chronic care management codes which are already used by the health care providers. Essentially, CPM encompasses all the services regularly provided each month to assist patients in pain management.

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