January 19, 2023 | By Scott Kraft, CPMA, CPC
Practices and providers can bill monthly chronic pain management services for Medicare patients beginning in 2023, using two new HCPCS G codes: G3002 and G3003. But these new codes come with specific guidelines that auditors will need to be on the lookout for when providers utilize these services.
First, G3002 is for the first 30 minutes per month of chronic pain management services. The first time a patient receives this monthly service, it must be face-to-face, though in subsequent months it can be furnished via telehealth.
In addition, G3002 requires a 30 minute visit each month between the patient and the rendering physician or other qualified health professional. With a Medicare reimbursement of approximately $80, interest among providers to furnish this service may suffer.
When services extend beyond 30 minutes, each additional 15 minute unit of service is supported with add-on code G3003. A unit of G3003 pays about $28.75 on a national average and there is no limit to the number of units per month.
Auditing these services starts with the requirement that the time be documented to support the units properly. A unit of G3002 requires the full 30 minutes and cannot be rounded up from a lower time unit.
Activities included in this service are:
- 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.
While the rendering provider must spend at least 30 minutes a month with the patient, additional activities can be furnished by ancillary staff under general supervision, meaning the rendering provider can be reached for questions but does not need to be in the office suite.
CMS clarifies in the 2023 Physician Fee Schedule Final Rule that these services can be performed at different intervals over the course of the month, and that every activity on the list of things included does not need to be billed every month.
In addition, the patient does not need to receive this service every month; providers may offer it in different months as necessary. There is no limit to the specialties that can render the service, and more than one provider of a different specialty can render this service to the same patient in the same month, as the ultimate goal is to encourage opioid management.
Lastly, a patient can receive an E/M service on the same day as the chronic pain management service, but there must be no overlay between the two services, including both the documentation requirements and the time as documented.