Posted on Jan 14, 2002

Effective Jan. 1, 2002, CMS recognizes a specialty designation for pain management physicians. Although Medicare’s adoption of this specialty code, -72, represents a major achievement for the field of pain management, the code is only for tracking pain management services. Medicare fees and coverage will be unaffected. However, Medicare’s decision may lead to a more appropriate level of reimbursement for treatment. Specialty designation is critical to reimbursement because practice-expense relative value units are developed separately by Medicare for each recognized specialty. Most practice expenses for pain management are now derived from anesthesiology, even though physicians of several specialties perform pain management procedures. The anesthesiology practice expense value (as reflected in the Physician Fee Schedule) is one of the lowest among medical specialties. According to Mary Jo Marcely, CPC, senior vice president of NAPA Management Services Corp., a Syracuse, N.Y., firm specializing in anesthesiology and pain management consulting and billing, “This designation will now allow Medicare to separately track pain management practice office-expense data. As Medicare begins to use this data in calculating its payments, it is anticipated that pain management specialists will experience a significant increase in reimbursement for treatment.” Marcely notes that the data collected may help reduce audits and cut the number of claims for pain management treatment suspended inappropriately by Medicare. The designation may mean greater involvement by pain management specialists in creating local medical review policies. CMS encourages local Medicare carriers to appoint advisory committee members from different specialties. Kimberly A. Kutska, a spokeswoman for the American Academy of Pain Management (AAPM), feels that the new specialty designation is an advantage for individuals covered under Medicare. “Specialty designation will help patients identify pain management providers,” she says. “Previously, Medicare may have listed these providers under another specialty code, such as anesthesiology or psychiatry, which the patient may not have immediately associated with pain management.” AAPM, the American Society of International Pain Physicians, the American Society of Anesthesiologists, and the American Medical Association worked with Congress and the Department of Health and Human Services to establish the new designation. Marcely advises that physicians can have only one specialty designation. Some local Medicare carriers require that physicians seeking the specialty designation recredential using form 855; other carriers will accept a letter from the physician requesting the designation. Physicians should contact their local Medicare carrier for guidelines.