ASRA Pain Medicine Update

ASRA Pain Medicine has released the latest fee schedule for commonly performed acute and chronic pain medicine procedures. This table replaces the information previously housed within the ASRA Coder App, which is no longer offered. View and download the sheet (membership required).

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Physician Fee Schedule (PFS). While generally anticipated, stakeholders were disappointed that the CY 2024 Medicare Physician Conversion Factor (CF) was reduced to $32.74, a 3.4% reduction from the 2023 CF of $33.89. The Medicare CF is a dollar conversion factor used to calculate payment rates for Medicare PFS services. To calculate rates, geographically adjusted relative value units (RVUs) representing work, practice expense (PE), and malpractice costs are multiplied by the CF.

While Congress has addressed physician payment cuts in year-end legislation in years past, in 2024, Congress passed short-term funding patches called Continuing Resolutions (CRs) instead. The latest funding patch passed Congress on January 18, 2024, and was signed by President Biden on January 19, 2024. The stopgap measure averted a partial government shutdown and funded government agencies at current levels through early March 2024. As a result, it is unlikely that Congress will address the 2024 physician payment cut until the new March deadline as Congress works to pass a budget for 2024.

While action by Congress is not guaranteed, stakeholders are hopeful that Congress will still address the 2024 payment cut. Anticipation for a complete reversal of the payment cut has been tamped down, and the current expectation is that Congress may only partially mitigate the 2024 payment cut.

In recent years, when payment cuts were addressed in the new year, the update was generally retroactive to the first of the year. Claims submitted before Congressional action were reprocessed. One scenario currently being discussed is that if Congress does not act until March, the update may not be retroactive to the first of the year. Under this scenario, the update would apply to claims moving forward from when the President signs the bill. The downside to this scenario is that the higher rate would not be applied to claims processed before Congress took action. But, since the money that Congress approves is being used over less time, the result would be a higher overall update for claims processed in the remaining months of 2024. Also, practices would not have the burden of reaching out to collect the difference in co-pays owed by patients that would have resulted once the higher payment was implemented. 

ASRA Pain Medicine will alert members as this situation evolves.

New/Revised CPT/HCPCS Code for 2024

Revised Codes

New Codes

Changes to Minimum Threshold Times for Evaluation and Management Services (99202-99205) and (99212-99215)

The time ranges in codes 99202-99205, and 99212-99215 have been changed to a minimum of total time, ie, a time threshold that must be met or exceeded. In accordance with the changes, the guidelines for selecting a level of service based on time have been revised to reflect these changes.

Please note: Every reasonable effort has been made to ensure the accuracy of the information in this document.  However, the ultimate responsibility for coding and claims submission lies with the provider of services (i.e., the physician, clinician, hospital, or other facility).  ASRA Pain Medicine makes no representation, guarantee or warranty, expressed or implied, that this report is error-free or that the use of this information will prevent differences of opinion with third-party payers and will bear no responsibility or liability for the results or consequences of its use.  Our recommendations do not guarantee coverage or payment, and providers should make every effort to validate correct coding and contracted payment rates with their respective coding staff, administration and payers.