Medicare Physician Fee Schedule Proposed Rule

Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. CMS is proposing new HCPCS codes and valuation for chronic pain management and treatment services (CPM) for CY 2023.

Proposed Codes for Chronic Pain Management

CMS believes the proposed CPM HCPCS codes would, if finalized, facilitate payment for medically necessary services, prompt more practitioners to welcome Medicare beneficiaries with chronic pain into their practices, and encourage practitioners already treating Medicare beneficiaries who have the pain to spend the time to help them manage their condition within a trusting, supportive, and ongoing care partnership. The proposed codes include a bundle of services furnished during a month that, CMS, believes to be the starting point for holistic chronic pain care, aligned with similar bundled services in Medicare, such as those furnished to people with suspected dementia or substance use disorders.

CMS is proposing to include the elements in the chronic pain management code like the diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and 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 coordination between relevant practitioners furnishing care, such as physical and occupational therapy and community-based care, as appropriate.

ICD-11 Chronic Pain Codes

As of January 1, 2022, the latest revision of the International Classification of Diseases (ICD), the ICD-11, became effective. Within the revisions are important changes and additions that affect people who live with chronic pain and the pain management specialists who diagnose and treat them. Pain specialists predict that a more accurate classification system and view of chronic pain will make life easier for those affected as well as the physicians and advanced practitioners who care for them.

A key ‘first’ in ICD-11 is that the new system provides a single diagnostic code for chronic pain (MG30.0 Chronic primary pain). The manual also provides other codes for the most common and relevant groups of pain conditions. Under the ICD-11, pain is not only recognized as a health condition on its own but is also recognized as a symptom that can be secondary to other underlying health issues. The revision makes clear that chronic pain can lead to disability and distress, which is likely to be a welcome direction for those who have experienced stigma toward their often invisible condition.

Chronic pain is reclassified in ICD-11. Under this new classification, chronic pain is defined as ‘pain that persists or recurs for more than 3 months,’ as it has been previously. The classification goes even further to differentiate types of pain. Pain can be the sole or a leading complaint, needing special treatment and care. Other subgroups specify that pain may be secondary to an underlying disease. For instance, there can be chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, and chronic secondary headache and orofacial pain, to name a few categories.

You can refer CMS article for more information on ‘Medicare Physician Fee Schedule (MPFS) Proposed Rule CY 2023’ and Practical Pain Management’s webpage for more information on ‘Chronic Pain Reclassification in ICD-11’. In case of any assistance is needed for medical billing and coding for your pain management practice, you can contact Medical Billers and Coders (MBC) at for more information. 

Published By - Medical Billers and Coders
Published Date - Jul-22-2022 Back

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