Outpatient Hospital Pain Rehabilitation Programs

CMS National Coverage Determination | ncd_id=24 | manual_section=10.4 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False

Coverage of services furnished under outpatient hospital pain rehabilitation programs, including services furnished in group settings under individualized plans of treatment, is available if the patient’s pain is attributable to a physical cause, the usual methods of treatment have not been successful in alleviating it, and a significant loss of ability by the patient to function independently has resulted from the pain. If a patient meets these conditions and the program provides services of the types discussed in §10.3, the services provided under the program may be covered. Non-covered services (e.g., vocational counseling, meals for outpatients, or acupuncture) continue to be excluded from coverage, and A/B Medicare Administrative Contractors would not be precluded from finding, in the case of particular patients, that the pain rehabilitation program is not reasonable and necessary under §1862(a)(1) of the Social Security Act for the treatment of their conditions.

Item/Service Description: Some hospitals also provide pain rehabilitation programs for outpatients. In such programs, services frequently are provided in group settings even though they are being furnished pursuant to each patient's individualized plan of treatment. Revision History: 09/1988 - Clarified that services furnished under outpatient hospital pain rehabilitation programs are covered if patient's pain is attributable to a physical cause, the usual methods of treatment have not been successful in alleviating it, and a significant loss of ability by patient to function independently has resulted from the pain. Effective date NA. (TN 32) Benefit Categories: 46 - Outpatient Hospital Services Incident to a Physician's Service Transmittal: transmittal_number=32 | transmittal_issue_date=1988-09-01