Chronic Pain Management G Codes

Question:

I'm struggling to understand the guidelines for HCPCS code G3002 and G3003. Is there any guidance you could provide?

Answer:

CMS's MLN006764 September 2024 provides guidance on the appropriate use of Chronic Pain Management (CPM) HCPCS codes G3002 and G3003. Medicare defines chronic pain as “persistent, or current pain lasting longer than three months.”

The HCPCS codes are used for reporting "chronic pain management” and treatment monthly bundle including:

• Diagnosis

• Assessment and monitoring diagnosis

• Administration of a validated pain rating scale or tool

• 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;

• Ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate.

Criteria and documentation requirements

The initial visit must be face-to-face visit for at least 30 minutes provided by a physician or other qualified health professional. 30 minutes must be met or exceeded to bill for G3002.

G3003 can be added for each additional 15 minutes of chronic pain management and treatment personally provided by a physician or other qualified health care professional, per calendar month. The entire 15 minutes must be utilized in to report.

You must develop and maintain a person-centered plan.

You must provide and document the elements listed in the code bundle to the first month for each patient. Subsequent months do not require all listed components.

Although this code was created by CMS, we recommend you reach out to your commercial payors as they may reimburse for them as well.

G3002 is billed once per calendar month. G3003 is billable for as many times as medically necessary within the calendar month and calculated in 15-minute increments.

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

*This response is based on the best information available as of 3/27/25.