Medicare Cover for Pain Management

Medicare Cover for Pain Management

It is observed that one in five Americans is living with some form of chronic or severe pain. According to a research study, the cost of pain to US is estimated at between $560 billion and $635 billion annually.

Moreover, people live with chronic pain are more in US than people suffering from cancer, diabetes, and heart disease combined. Hence pain management stakeholders are working to improve care for those suffering from acute and chronic pain in an era challenged by the opioid crisis.

In the past two decades overdose of Prescription opioids, heroin, and synthetic opioids are responsible for an unprecedented rise in the number of deaths.

Here are some interesting facts according to the Centers for Disease Control and Prevention (CDC):

  • The amount of pain that Americans report remains unchanged still the number of opioid prescriptions dispensed has quadrupled since 1999
  • 96 percent of 10.3 million people age 12 or older who misused opioids (in 2018) abused prescription pain relievers
  • Roughly 25 percent of patients receiving long-term opioid therapy in a primary care setting struggle with opioid use disorder

Initial evaluation, including assessment of both the medical and the probable biopsychosocial factors causing or contributing to a pain condition are critical and important part of providing comprehensive care in pain management.

A second critical step is to build a treatment plan address both the causes of pain and to manage pain that persist even after treatment. Quality pain diagnosis and management both are offering alternatives to opioids as well as states when opioids may be appropriate.

Now, let’s understand Medicare Cover for Pain Management

Many treatments and services used in pain management are covered in Original Medicare, Medicare Advantage, and prescription drug plans. However, which benefit the coverage falls under will depend on how the treatment is given or administered.

Here you can find an overview of the various Medicare parts that help you to pay for pain management as well as what kind of therapies are provides.

Medicare Part A

Hospital admissions, skilled nursing facility care, and hospice are eligible to pay under part A.

If a person’s pain is managed by prescription medication while an inpatient in a hospital or hospice, the cover will come from Part A.

An individual may require to pay a $5 co-payment for pain medication in some hospice care.

Medicare Part B

Part B generally pays for services that helps for management of your pain.

These services are follows:

Medication:

Acetaminophen and ibuprofen are called Common pain-relievers as well as they help to reduce inflammation.

Acupuncture:

It is a Chinese medicine involves the stimulation of specific points on the body, usually through the insertion of thin needles into the skin, may help low back pain.

Part B covers up to 12 visits in 90 days for chronic low back pain and an additional eight sessions if the patient is improving.

Physical therapy:

It emphasis on how to use body correctly. Moreover, it is a rehabilitative process that may include techniques, such as heat and cold, exercise, massage, and electrical stimulation, to improve functioning and manage acute or chronic pain.

Occupational therapy:

OT helps patients get back to their normal daily activities and therapist assist patients with durable medical equipment and pain management strategies.

Chiropractic spinal manipulation:

It involves manipulation or adjustment of the spine and other parts of the body and Part B covers manual manipulation of the spine to correct subluxation only. No other tests or services are covered.

Behavioral health integration services:

Psychotherapy which is a one form of Cognitive behavioral therapy can help patients change their thinking patterns to change unhealthy behavior or moods.

When certain conditions are met, then Medicare covers behavioral health services for individuals as well as for groups.

Alcohol use disorder screening and counseling:

There is an increase use of alcohol in those suffering from chronic pain and may lead to various health problems.

Part B covers Screening of 1 alcohol misuse and max 4 brief counseling sessions in a year.

Depression screening:

Depression can be triggered by chronic pain and depression can make pain worse.

Part B covers 1 screening per year with doctors who is authorized to order treatment or give a referral.

In some cases, part B may cover prescribed drugs, such as when a doctor is required to administer the medication in their office.

Medicare Part C

Medicare Part C also called as Medicare Advantage. It is administered by private insurance companies.

The plan is called advantage plan because it combines the benefits of parts A and B, and coverage will be the same and subject to the same rules.

Extra pain management services may be offer by some plans as an additional benefit. For instance, a person can explore the coverage options available to them after checking with the plan provider.

Medicare Part D (prescription drug plans)

This plan can be administered by Private insurance companies.

Part D covers some pain management, such as prescription opioids and Medication Therapy Management (MTM).

The opioid crisis makes the practice of pain management more complicated and they have influenced one another as each has evolved in response to various pressures and influences.

A multidisciplinary approach that includes a comprehensive, multimodal plan for pain management is useful to improve the quality of pain care and evade opioid-related risks.

Generally, most Medicare plans covers pain management therapies and services if they are certified as medically necessary by a healthcare provider.

Are You Ready to Get Billing?

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