CurrentPriority HealthPolicy BILLING POLICY No. 049

CHRONIC PAIN CARE MANAGEMENT SERVICES

Governs billing and documentation requirements for monthly chronic pain management services for Priority Health members, including allowable codes, service components, and submission expectations for providers.

Policy Summary

PayerPriority Health

PolicyCHRONIC PAIN CARE MANAGEMENT SERVICES

Policy CodePolicy BILLING POLICY No. 049

Change TypeDisclaimer addedadministrative revisions

Effective DateJan. 2023

Next Review Date

Key ActionObtain required authorizations and ensure documentation of medical necessity before billing; an authorization does not guarantee payment if billing or coding requirements are not met.

SourceLink

POLICY UPDATE CHANGES

Added 'Disclaimer' section.

Revisions noted with no changes made on June 4, 2025 and April 30, 2026.

2billing codes defined (G3002, G3003)

30mG3002 minimum time (initial)

15mG3003 increment

1/moG3002 billing frequency

virtual OKtelehealth allowance

Chronic Pain Management Coverage Criteria

Covered when ALL of the following are met:

Member has chronic pain (persistent or recurring pain lasting longer than three months) documented in the medical record

Services are provided by a physician or other health care professional who can bill Priority Health

ALL of the following

G3002: initial monthly bundle visit of at least 30 minutes; 30 minutes must be met or exceeded
G3002 may be billed once per calendar month

Policy Summary

PayerPriority Health

PolicyCHRONIC PAIN CARE MANAGEMENT SERVICES

Policy CodePolicy BILLING POLICY No. 049

Change TypeDisclaimer addedadministrative revisions

Effective DateJan. 2023

Next Review Date

Key ActionObtain required authorizations and ensure documentation of medical necessity before billing; an authorization does not guarantee payment if billing or coding requirements are not met.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

ALL of the following

Document the specific services provided that comprise the chronic pain management bundle (diagnosis, assessment and monitoring, administration of validated pain rating scale/tool)
Document development, implementation, revision and/or maintenance of a person‑centered care plan (strengths, goals, clinical needs, desired outcomes) and overall treatment management
Document facilitation/coordination of behavioral health treatment, medication management, pain and health literacy counseling, any chronic pain–related crisis care, and ongoing communication/care coordination with relevant practitioners

Billing Codes and Time Requirements

Chronic pain management codesHCPCSCovered

G3002	Chronic pain management and treatment, monthly bundle (initial visit >=30 minutes) including assessment, care plan development, medication management, coordination, counseling, crisis care, and ongoing communication.
G3003	Each additional 15 minutes of chronic pain management and treatment (per calendar month) billed in addition to G3002.

Time requirements for chronic pain management codes

G3002 time requirementInitial visit must be at least 30 minutes per calendar month; 30 minutes must be met or exceeded.

G3002 billing frequencyCan be billed once per calendar month by a physician or other Priority Health–billing qualified health care professional.

G3003 time incrementEach additional unit represents 15 minutes; 15 minutes must be met or exceeded for each instance.

G3003 billing frequencyMay be billed multiple times per calendar month as medically necessary, when billed in addition to G3002.

Telehealth allowanceBoth G3002 and G3003 can be billed virtually.

Authorization and Medical Necessity

Prior Authorization

Authorization and Medical Necessity Required

Authorization and medical necessity appropriate to the procedure, diagnosis, and frequency are required; an authorization does not guarantee payment if billing/coding or documentation requirements are not met.

Follow CPT, HCPCS, and revenue code guidance and submit industry‑standard, compliant codes only for services performed and fully documented.
Failure to document services rendered or items supplied will result in a denial; Priority Health may reject/deny claims or recover payment for noncompliant submissions.
Payment integrity pre- or post-claim reviews may be performed to validate billing and coding accuracy.

OpenPayer

CHRONIC PAIN CARE MANAGEMENT SERVICES

Chronic Pain Management Coverage Criteria

Billing Codes and Time Requirements

Authorization and Medical Necessity

Key Definitions