What the New CMS Medicare Pain Codes Mean for You
By Jill Waldbieser
Anyone who lives with chronic pain—or cares about someone who does—knows that treatment can be complex, time-consuming, and costly. At the start of 2023, the Centers for Medicare and Medicaid Services (CMS) took a major step toward eliminating some of those obstacles when it debuted the first-ever specialized billing codes for chronic pain management in the Medicare program.
The two new codes, G3002 and G3003, allow health care practitioners to be reimbursed for chronic pain management, including coordinating with other specialists. G3002 covers monthly chronic pain management, treatment, assessment, monitoring, and more for a 30-minute visit, while G3003 references each additional 15 minutes spent on pain management and treatment each month.
The new codes outline best practices in chronic pain care based partially on the findings of the Congressionally mandated Department of Health and Human Services Pain Management Best Practices Inter-Agency Task Force created in 2018.
“Chronic pain management is complex, and there were no existing codes that accounted for all the tasks required to care for a patient with chronic pain,” says Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, who authored U.S. Pain’s recommendation to CMS regarding the codes.
Addressing pain in the populations served by Medicare—including Americans age 65 and up and individuals with disabilities—was especially important given the prevalence of age-related chronic pain conditions such as arthritis, cancer, and diabetic neuropathy, and the fact that pain is the number-one reason for disability in the United States, Steinberg points out. The creation of these codes, she says, “is a big deal.”
What the codes cover
The new pain management codes require physicians, nurse practitioners, and physician assistants to spend a minimum of 30 minutes each month with individuals living with chronic pain.
“One of the impediments to the effective treatment of chronic pain is that patients may not have the time that they need with their treating clinicians,” says Shari Ling, MD, deputy chief medical officer for CMS. “The care experience may be abrupt and fragmented. We hope these codes can be useful in addressing some of the barriers clinicians and beneficiaries face.”
The best way to manage chronic pain is with individualized care plans, agrees Steinberg—considering goals, clinical needs, and desired outcomes—which is why it was also important that the codes accommodate the necessity of collaborative care in pain treatment. Medication, restorative therapies such as physical therapy, interventional procedures, behavioral health, and complementary modalities such as acupuncture all can play a role in pain management and quality of life. The new codes can encourage coordination of care by reimbursing for the lead practitioner’s time spent communicating with other care providers.
Although an initial in-person assessment by a health care provider is required, the codes permit telehealth for subsequent visits. Telehealth is an important tool for people living with pain who may experience physical difficulty getting to a doctor’s office, sitting in a waiting room, or navigating parking, Steinberg points out.
Finally, the codes require doctors to obtain and document patients’ consent at the initial visit.
“Having patients understand what is required by the new codes allows them to see that they are part of a process and are viewed as a partner with the physician,” says Steinberg. “It needs to be a patient-centered plan, and the patient needs to be consulted as part of it.”
What the codes mean for pain care
In addition to their practical benefits, the new pain codes also represent a form of validation for those living with chronic pain, many of whom have struggled to receive care in the past.
“Chronic pain is not the same as acute pain. Chronic pain is its own disease,” says Steinberg. “That’s an important paradigm shift that not all physicians, and definitely not the public, have made. Having a standalone code helps chronic pain be seen as the chronic disease of the nervous system and brain that it really is. It will signal to physicians that when patients have complaints of pain, it is critical to take them seriously, conduct a thorough pain assessment, and develop a comprehensive plan of care.”
Ling says the codes have been well-received so far. She and others at CMS see this step as a starting point for improving care for those living with pain.
“Effective care really depends on goal clarity and having a care plan that aligns with those treatment goals,” Ling says. “We are committed to learning everything we can from how these codes are utilized.”
The lack of a standalone code for pain in the past has affected the ability to gather accurate data on the scope and cost of chronic pain. “It could be argued that the lack of such critical data has contributed to the poor state of pain care and treatment in the United States,” Steinberg says.
Now that CMS will be better able to capture and understand the extent of pain care required in the United States, and the cost of that care—including in the aging and disabled American population—it could set an important precedent. “Medicare is often a bellwether for private insurance coverage,” says Steinberg. “The hope is that private insurers will begin to recognize the enormous burden of insufficiently treated chronic pain and begin to cover care like this.”
In the meantime, individuals living with chronic pain who are covered by Medicare should discuss the new codes with their providers—sharing resources such as this article may help.
“We understand that some people with chronic pain have had to forgo the care that they needed,” Ling says, “and that's a problem we’d like to be able to solve.”