Chronic Pain Management
A monthly bundled service for patients with chronic pain lasting longer than 3 months, covering a person-centered care plan, medication management, and coordination with behavioral health and rehab providers.
What it is
Chronic Pain Management and treatment (CPM) pays for a monthly bundle of non-face-to-face care for patients with chronic pain, which CMS defines as persistent or recurrent pain lasting longer than 3 months.
The bundle covers diagnosis and assessment, administration of a validated pain rating scale, a person-centered care plan, medication management, pain and health literacy counseling, coordination with behavioral health and rehabilitation providers (such as physical or occupational therapy), and any necessary chronic-pain-related crisis care.
Who qualifies
- Patient has chronic pain: persistent or recurrent pain lasting longer than 3 months
- An initiating visit establishes the diagnosis, care plan, and patient consent (its time can count toward the first month's G3002 threshold if at least 30 minutes and all required elements are met)
- Documented patient consent to CPM, including any applicable cost-sharing
- Only one practitioner or practice bills CPM for a given patient in a given month
Codes at a glance
| Code | What it covers | Threshold | Approx. payment | Details link |
|---|---|---|---|---|
| G3002 | Chronic pain management and treatment, first 30 minutes of physician or QHP time, per calendar month | 30 minutes physician/QHP time, plus the required care-plan and assessment elements | ~$86 | Details → |
| G3003 | CPM add-on, each additional 15 minutes of physician or QHP time | Each additional 15 minutes, requires G3002 first | ~$32 | Details → |
Approximate CY2026 Medicare Physician Fee Schedule national non-facility payment benchmark for non-QP clinicians, before geographic, sequestration, and claim-specific adjustments. Actual reimbursement varies by locality, practitioner status, payer, and billing circumstances. Verify the applicable amount with CMS or your Medicare Administrative Contractor.
What's required to bill
- Documented patient consent to CPM, including any applicable cost-sharing
- A person-centered care plan covering strengths, goals, clinical needs, and desired outcomes, developed, implemented, and revised as needed
- Administration of a validated pain rating scale
- Medication management specific to the patient's chronic pain
- Coordination with other practitioners furnishing related care (e.g., physical therapy, occupational therapy, behavioral health, complementary/integrative approaches)
- Overall treatment management and any necessary chronic-pain-related crisis care
- Only one practitioner bills CPM per patient per calendar month
Documentation checklist
- Signed or verbally-documented CPM consent in the chart
- A written, person-centered care plan accessible to the care team
- Validated pain rating scale results for the month
- Time log showing physician/QHP time for G3002/G3003
- Evidence of coordination with other treating practitioners (physical therapy, occupational therapy, behavioral health, and similar)
Common billing mistakes
- Billing G3003 without first meeting the G3002 30-minute threshold
- More than one practitioner or practice billing CPM for the same patient in the same month
- No documented validated pain rating scale or person-centered care plan
- Billing CPM alongside CCM, PCM, or BHI for the same patient using the same time or activities, instead of separating the distinct work performed under each
- Treating the initiating visit as automatically satisfying the monthly time requirement without confirming at least 30 minutes and all required elements were actually met
FAQ
What counts as chronic pain for CPM?
CMS defines it as persistent or recurrent pain lasting longer than 3 months. There's no specific diagnosis code requirement beyond documenting the duration and its impact on the patient.
Can CPM be billed alongside Chronic Care Management (CCM)?
Both can be furnished, but the same practitioner can't bill CPM and CCM for the same patient using the same time or activities in the same month; each service needs its own distinct, non-duplicated time and documentation.
Is a face-to-face visit required to start CPM?
Yes. An initiating visit is required to establish the diagnosis, care plan, and consent before ongoing CPM services can be billed. That visit's time can count toward the first month's G3002 threshold if it meets all the required elements.