How MPFS is Changing Pain Management Billing for 2023

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How MPFS is Changing Pain Management Billing
for 2023
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How MPFS is Changing Pain Management Billing for
2023
CY 2023 Medicare Physician Fee Schedule
(MPFS) The Centers for Medicare and Medicaid
Services (CMS) on Nov. 1, 2022, released the
final 2023 Medicare Physician Fee Schedule
(MPFS), addressing Medicare payment and quality
provisions in the coming year. Lets understand
how MPFS is changing pain management billing for
2023. Through CMS, federal government making
efforts to effectively address pain management as
a response to the nations overdose crisis,such
as the National Pain Strategy and the HHS Pain
Management Best Practices Inter-Agency Task Force
(PMTF) Report. Several sections of the SUPPORT
Act describe actions the Department of Health and
Human Services has been directed to take to
improve pain care, such as section 2003, which
amended Medicares Annual Wellness Visit to
include a review of factors for evaluation
related to pain for patients using opioid
medications. In the section 6032 Report and the
Action Plan, CMS included a recommendation to
explore the possibility of establishing a new
bundled payment under the Medicare Physician Fee
Schedule for integrated multimodal pain care that
could include certain elements such as diagnosis,
a person-centered plan of care, care
coordination, medication management, and other
aspects of pain care. Chronic Pain Management
and Treatment Services In CY 2023 MPFS, CMS
finalized new HCPCS codes, G3002 and G3003, and
valuation for chronic pain management and
treatment services (CPM) for CY 2023.
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How MPFS is Changing Pain Management Billing for
2023

• CMS believe the CPM HCPCS codes will improve
  payment accuracy for these services, prompt more
  practitioners to welcome Medicare beneficiaries
  with chronic pain into their practices, and
  encourage practitioners already treating Medicare
  beneficiaries who have chronic pain to spend the
  time to help them manage their condition within a
  trusting, supportive, and ongoing care
  partnership. The finalized codes include a bundle
  of services furnished during a month that will
  act as 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 have finalized the CPM codes to
  include the following elements in the code
  descriptor
• 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 coordination
  between relevant practitioners furnishing care,
  such as physical and occupational therapy,
  complementary and integrative care approaches,
  and community-based care, as appropriate.

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How MPFS is Changing Pain Management Billing for
2023
Opioid Treatment Programs (OTPs) In order to
stabilize the price for methadone for CY 2023 and
subsequent years, CMS is finalizing the proposal
to revise our methodology for pricing the drug
component of the methadone weekly bundle and the
add-on code for take-home supplies of methadone.
As proposed, CMS will base the payment amount for
the drug component of HCPCS codes G2067 and G2078
for CY 2023 and subsequent years on the payment
amount for methadone in CY 2021 and update this
amount annually to account for inflation using
the PPI for Pharmaceuticals for Human Use
(Prescription). Additionally, based on the
severity of needs of the patient population
diagnosed with opioid use disorder (OUD) and
receiving services in the OTP setting, CMS is
finalizing the proposal to modify the payment
rate for the non-drug component of the bundled
payments for episodes of care to base the rate
for individual therapy on a crosswalk to a code
describing a 45-minute session, rather than the
current crosswalk to a code describing a
30-minute session. This will increase overall
payments for medication-assisted treatment and
other treatments for OUD, recognizing the longer
therapy sessions that are usually required. CMS
is also finalizing the proposal to allow the OTP
intake add-on code to be furnished via two-way
audio-video communications technology when billed
for the initiation of treatment with
buprenorphine, to the extent that the use of
audio-video telecommunications technology to
initiate treatment with buprenorphine is
authorized by the Drug Enforcement Administration
(DEA) and Substance Abuse and Mental Health
Services Administration (SAMHSA) at the time the
service is furnished.
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How MPFS is Changing Pain Management Billing for
2023
CMS is also finalizing the proposal to permit the
use of audio-only communication technology to
initiate treatment with buprenorphine in cases
where audio-video technology is not available to
the beneficiary, and all other applicable
requirements are met. Additionally, CMS is
allowing periodic assessments to be furnished
audio-only when video is not available for the
duration of CY 2023, to the extent that it is
authorized by SAMSHA and DEA at the time the
service is furnished. CMS is clarifying that OTPs
can bill Medicare for medically reasonable and
necessary services furnished via mobile units in
accordance with SAMHSA and DEA guidance. CMS is
finalizing the proposal that locality adjustments
for services furnished via mobile units would be
applied as if the service were furnished at the
physical location of the OTP registered with DEA
and certified by SAMHSA. Chronic Pain Management
and Behavioral Health Services As described in
Goal 3 of CMSs 2022 Behavioral Health Strategy
(Strategy), CMS intends to improve the care
experience for individuals with acute and chronic
pain, expand access to evidence-based treatments
for acute and chronic pain, and increase
coordination between primary and specialty care
through payment episodes, incentives, and payment
models.
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How MPFS is Changing Pain Management Billing for
2023
Rural Health Clinics (RHCs) and Federally
Qualified Health Centers (FQHCs) CMS is
finalizing the addition of chronic pain
management and behavioral health integration
services to the RHC and FQHC specific general
care management HCPCS code, G0511, which aligns
with changes made under the PFS for CY 2023.
Since the requirements for the chronic pain
management and behavioral health integration
services are similar to the requirements for the
general care management services furnished by
RHCs and FQHCs (which are the current services
for which RHCs and FQHCs can use HCPCS code
G0511) the payment rate for HCPCS code G0511 will
continue to be the average of the national
non-facility PFS payment rates for the RHC and
FQHC care management and general behavioral
health codes (CPT codes 99484, 99487, 99490, and
99491) and PCM codes (CPT codes 99424 and 99425)
Payment will be updated annually based on the PFS
amounts for these codes, which is how these
updates are made currently. We referred CMS
announcement on Calendar Year (CY) 2023 Medicare
Physician Fee Schedule Final Rule to discuss how
MPFS is changing pain management billing for
2023. Legion Healthcare Solutions is a leading
medical billing company providing complete
billing and coding services. We can help you in
receiving timely and accurate reimbursements for
pain management services. To know more pain
management billing services, contact us at
727-475-1834 or email us at info_at_legionhealthcares
olutions.com
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