The 2025 Pain Management CPT Codes Are Posted to the AAPM Member Dashboard.
The Coding and Reimbursement Committee has updated the coding information available on the AAPM website. New charts that include information concerning Medicare’s 2025 Relative Value Units (RVUs) for codes commonly reported by Pain Medicine Physicians have been posted. The title page provides links to CMS web pages that provide additional information and outline the basis for the 2025 reimbursement rates.
The charts are organized according to the type of service (e.g. E/M, injections, radiology) with new and revised codes highlighted. There is also a separate worksheet that lists all the new and revised codes for 2025. As appropriate, some charts contain information indicating which codes include imaging guidance as well as which codes can be reported with the bilateral modifier. The Relative Value Units in the charts reflect the combined RVUs for physician work, practice expense, and professional liability (total RVUs). RVUs in the “facility” column are used to calculate payments in the hospital or other facility setting. RVUs in the “non-facility” column are used for services provided in a physician’s office.
The chart of Common Pain Medicine Codes can be accessed on your AAPM Member Dashboard.
Coding for E/M Services and Procedures on the Same Day: Supporting Both Services for Reimbursement
According to CPT, both an Evaluation and Management (E/M) service and a procedure code can be reported if the patient’s condition requires a significant, separately identifiable E/M service. “Significant” implies that the E/M service required medical decision making sufficient to meet the E/M level of service requirements. “Separately identifiable” suggests that the visit is distinct from the procedure. In other words, the E/M service should be above and beyond the pre- and post-procedure care typically provided. Therefore, simple confirmation of symptoms, explanation of the procedure, signing of consents, and verification of medical information are typically considered inherent in the procedure code and were considered in the RVU value of the procedure.
In general, you report both the E/M service and the procedure if:
- An evaluation resulting in an initial decision to perform the procedure was made at the same encounter as the procedure, regardless of the diagnosis, or
- The diagnosis for the E/M service was different from the one for the procedure because two separate conditions were managed.
Generally, report only the procedure if:
- The decision to perform the procedure was made at another visit, or
- The E/M service doesn’t reflect a distinct and significant clinical evaluation on the day the procedure was performed.
When reporting both services, the modifier 25 must be appended to the E/M code to confirm that distinct services were performed. CPT states that a significant, separately identifiable E/M is “defined or substantiated” by documentation that satisfies the relevant criteria for the E/M service. Therefore, it is important to clearly document a distinct visit when reporting a procedure on the same day.
CPT and Medicare have similar rules governing the reporting of visits on the same day as a procedure. Although many third-party payers follow CPT guidelines, others may have their own guidelines based on internal payment policies. It is important to remember that following proper coding rules does not guarantee reimbursement.
The chart of Common Pain Medicine Codes can be accessed on your AAPM Member Dashboard.
