Does Medicare Cover Pain Management?

Does Medicare cover pain management? Though we certainly don’t welcome pain, it serves an important role by alerting us of an injury or health issue.

Our natural tendency to avoid pain keeps us safe in most cases. We look for solutions to get rid of the pain, so we seek medical attention or apply a self-care treatment.

But when you have a chronic condition, experience depression, or undergo painful treatments for a disease, sometimes the best you can do is manage the pain.

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Pain Management Overview

Pain management is a field in itself, a branch of medicine developed to alleviate suffering and enhance the quality of your life.

Since lessening pain can involve medication, therapy, and relaxation techniques, many professionals are called into play. Your pain management team may include a pharmacist, physical therapist, psychologist, and/or other qualified practitioners.

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Medicare Pain Management Coverage

Your Medicare benefits include the following pain management services:

Prescription medication management

• Requires that you are enrolled in Part D
• Provides benefits according to your Medicare drug plan’s coverage rules

Behavioral health integration services

• For depression, anxiety and other mental health conditions
• Available if your health care provider offers a Psychiatric Collaborative Care Model, which is a group of integrated behavioral health support services
• Your costs: monthly fee, Part B deductible and coinsurance

Occupational and physical therapy

• Includes help with managing day-to-day life functions like bathing and dressing
• Unlimited sessions for provider-certified outpatient services if deemed medically necessary
• Your costs: 20% coinsurance and Part B deductible

Manual spine manipulation

• Medically necessary manual manipulation to remedy a subluxation (when a bone is partially displaced from a joint)
• Provider can be chiropractor or other qualified practitioner
• Your costs: 20% coinsurance and Part B deductible

Alcohol misuse screening and counseling

• Misuse: Up to four face-to-face counseling sessions annually
• Misuse but not alcohol-dependent: Up to one screening per year
• Counseling rendered in a primary care setting by a primary care practitioner
• Your costs: none if your provider accepts assignment (Medicare-approved amount)

Depression

• One depression screening annually
• Services in a primary care setting where you can get follow-up treatment and/or professional referrals
• Your costs: none if your provider accepts assignment (Medicare-approved amount)

Acupuncture

• To reduce chronic low back pain that has lasted at least 12 weeks due to an unknown cause
• Up to 12 visits within 90 days, potentially extended to 20 treatments yearly if improvement is evident
• Requires practitioner with very specific credentials
• Your costs: need to check with Medicare or your plan

Pain Management Resources

The International Association for the Study of Pain (IASP) provides links to an extensive list of organizations that provide information related to research, treatment and education related to pain.

If you have Medicare Advantage, check your plan materials for coverage that may extend beyond Original Medicare. If you have Medigap, your plan should cover some out-of-pocket costs.