Medicare Billing for Chronic Pain Management: Best Practices and Guidelines
Chronic pain is one of the most severe health issues in the United States, costing the country billions of dollars in lost work time and productivity, as well as a lower quality of life. It is estimated that between 11% and 40% of persons in the United States suffer from chronic pain. As pain medicine specialists focus on providing patient-centered and coordinated care, they must also deal with growing insurance company scrutiny, expanding prior authorization requirements, changing codes, fee schedule decreases, and more patient financial responsibility. Let’s have a glimpse of the best practices and guidelines for chronic pain management billing:
Best Practices for Chronic Pain Management Billing:
- Stay Updated:
- Verify insurance coverage and benefits:
- Prior authorizations:
Guidelines for Chronic Pain Management Billing:
It is critical for practices to keep up with CPT code revisions. Physicians execute various needle treatments and must understand how to utilize the appropriate codes on claims. Let's look at some trigger point injection coding:- CPT codes 97810 - 97814 are assigned to acupuncture treatments. Beginning January 21, 2020, Medicare will pay for all modalities of acupuncture, including dry needling for chronic low back pain, subject to specific guidelines outlined in National Coverage Determination (NCD) 30.3.3.
- There are guidelines for coding trigger point injections as well as tendon sheath, ganglion cyst, ligament, carpal, and tarsal tunnel injections. Code 20552 is for injections of one or two muscle groups, whereas code 20553 is for injections of three or more muscle groups. Per session, only one of these codes can be billed.
- Regardless of the number of injections at any particular site or the number of sites, the number of services for each code is one.
- Other trigger point injection codes are:
- 20560 and/or 20561, dry needling
- 20550, injection(s); ligament, tendon sheath
- 20551, tendon origin/insertion
- 28899 (unilateral procedure, toe or foot)
- You must bill trigger point injections on only one line, irrespective of the number sites. Multiple injections at the same place per day are regarded as one injection and should be coded with one unit of service (NOS 001).
For 2023, CMS has proposed new HCPCS codes and valuation for chronic pain management and treatment services (CPM). That’s why there is a need to look for chronic pain management services.
But what to Look for in Chronic Pain Management Billing Services!
Are you looking for accurate and timely chronic pain management billing services?If yes, then you should ensure the presence of the following aspects:
- Your claims should be handled by dedicated processing professionals who are familiar with the chronic pain management laws of workers’ compensation, no-fault, and other payers.
- Most delayed and refused claims are due to coding errors - a chronic pain management billing professional should understand and be competent in applying the particular coding of chronic pain treatment.
- Payer pre-authorizations must be acquired and kept on file unless each treatment necessitates a new authorization. One of the most significant benefits of hiring a competent chronic pain management billing service is having a medical billing agency that understands and works closely with a range of payers and is familiar with their specific requirements.
- A good chronic pain management billing company should also provide additional services to help you supervise your revenue cycle, such as changes and demographics in patients and enrollments, A/R management for patients and insurance, account analysis to learn payer patterns and where your practice may be "leaking" money from unpaid but payable claims and other sources.
See also: Hospital Revenue Cycle: Trends In Billing And Collection Services