Chronic Pain Management Treatment and Services

Published 03/21/2025

The Centers for Medicare & Medicaid Services (CMS) has defined "chronic pain" as pain that continues to occur 12 weeks after the initial onset of the pain; or pain that remains present for a minimum of three months.

In a recent study (PDF), CMS identified that nearly 80 percent of the Medicare population experiences chronic pain. In fact, nearly 90 percent of beneficiaries under the age of 65 (who are eligible for Medicare due to a disability) experience chronic pain in comparison to approximately 80 percent of older beneficiaries. Findings within the survey study conducted by the Medicare Current Beneficiary Survey also identified the following:

  • Female beneficiaries experience chronic pain at a higher rate than males
  • More than 83 percent of beneficiaries experience chronic pain in more than one location
  • The most common location of pain is the hips, knees, and/or feet, followed by the back, hands, arms and/or shoulders
  • More than half of Medicare beneficiaries state that chronic pain limits their life and/or work

Providers treating patients with chronic pain are reminded to perform and document the following information within the medical record:

  • A full assessment/detailed physical examination of the area in which the pain is located
  • The level of pain intensity 
  • The pathophysiology of the pain
  • A detailed pain history 
  • Any prior pain treatments; including medications and/or therapies 
  • All response to current/prior pain treatments, medications, and/or therapies
  • Full review of any/all diagnostic tests 

Medicare Part B covers the following pain management services that may assist in managing patient care:

Most pain management services include a 20 percent beneficiary copay of the Medicare-approved amount for provider visits for diagnosis and/or treatment; part B deductibles also apply. Services in the hospital outpatient clinic/department may include an additional coinsurance or copay for hospital services. 

Many types of medication therapies for chronic pain treatment may also be covered with Part B or D Medicare drug coverage. Utilize this link more information regarding drug plan rules, prior authorization, etc. Follow this link for more information regarding Drug Management Programs and Medication Therapy Management. 

Recent studies have investigated a range of non-invasive treatments that support improvement in function and pain for specific chronic pain conditions. These studies support clinical approaches that focus on non-pharmacological and non-invasive therapies. Consequently, it is imperative that all providers promote nonopioid therapies as they can be more effective and safer than opioid pain management. As per the Centers for Disease Control (CDC), depending on the type of pain, alternative options to non-invasive treatments may include:

  • Over the counter (OTC) pain relievers, anti-inflammatory medications, and non-steroidal anti-inflammatory drugs (NSAIDs) 
  • Other medications for depression or for seizures, also used to treat pain
  • Cognitive behavioral therapy (CBT) — a psychological, goal-directed approach in which patients learn how to modify physical, behavioral, and emotional triggers of pain and stress
  • Exercise therapy, including physical therapy
  • Interventional therapies, like injections
  • Exercise
  • Weight loss
  • Other therapies such as acupuncture and massage

Chronic pain may also lead to stress, anxiety, depression, insomnia and other sleep disorders. Therefore, treatment beyond the actual pain symptoms may be required. Such treatment may include a multidisciplinary team approach addressing both the physical and psychological factors related to/caused by chronic pain. These types of services may also be covered with the Part B Medicare benefit. In fact, the beneficiary pays nothing for a yearly depression screening if their provider participates in the Medicare program.

Once the beneficiary meets their Part B deductible, they pay 20 percent of the Medicare-approved amount for visits to the healthcare provider to diagnose and treat their mental health condition. 

Medicare Part B mental health service coverage includes:

  • One depression screening per year. The screening must be conducted in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals
  • Individual and group psychotherapy with doctors (or with certain other Medicare-enrolled licensed professionals, as per state regulations)
  • Family counseling, if the main purpose is to help treatment
  • Testing to find out if the services and current treatments are helping the patient
  • Psychiatric evaluation
  • Medication management
  • Certain prescription drugs that aren’t usually “self-administered” 
  • Diagnostic tests
  • Partial hospitalization
  • Intensive outpatient program services
  • Mental health services as part of substance use disorder treatment
  • A one-time "Welcome to Medicare" preventive visit which includes a review of possible risk factors for depression
  • A yearly "Wellness" visit

Providers, remember to talk to your patients about their pain and how it may affect their everyday life and mental health. Also, remind them that the Medicare benefit will assist in covering treatments and services that will assist and/or improve their current and/or future health and well-being.

References and Resources


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