Chronic Pain Management for Providers

Chronic Pain Management (CPM) is a monthly Medicare benefit for patients with persistent or recurring pain. Each calendar month, a physician or other qualified health professional personally delivers a bundled set of services: Pain assessment, a person-centered care plan, medication management, behavioral health and care coordination, and crisis care when needed. CPM requires an initial face-to-face visit of at least 30 minutes and documented patient consent. Time is billed under HCPCS G3002 (first 30 minutes) and G3003 (each additional 15 minutes, up to four units per month).

Patients are eligible if they are under the care of a Medicare-enrolled physician or other qualified health professional, have a chronic pain condition that requires ongoing management, have received an initial face-to-face visit of at least 30 minutes from the billing physician or qualified health professional, and have documented consent in the medical record.

CPM time must be personally provided by a physician or other qualified health professional. This includes physicians (MD, DO), nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse-midwives. Unlike CCM and CHI, the time billed under G3002 and G3003 cannot be delegated to auxiliary personnel, care coordinators, or community health workers.

The initial visit must be face-to-face. Subsequent monthly service time can be provided through the modalities appropriate to the clinical situation, including phone and video, as long as the work is personally performed by the physician or qualified health professional and documented in the medical record.

The patient must be informed about the service, any cost-sharing that applies, that only one practitioner can bill CPM per calendar month, and their right to stop services at any time. Consent can be verbal or written and must be documented in the patient’s medical record.