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Pain Medicine

ASA considers pain medicine a top priority of the organization and advocates for its members on issues related to pain medicine out of the Office of Governmental and Legal Affairs in Washington, D.C. The resources on this page are designed to inform you about federal legislative and regulatory activities that may impact the practice of pain medicine. 

Learn about state activities on pain medicine.


Scope of Practice

Patient Protection and Affordable Care Act (PPACA)

Essential Health Benefits

Institute of Medicine (IOM) Report on Pain

Prescription Drug Abuse

E-Prescribing (eRx) Incentive Program

ASA Nomination Letters

Payment Issues

Reuse of Single Dose Vials

Scope of Practice

Interventional Pain Management is the Practice of Medicine

Pain Care Coalition Urges Federal Trade Commission to prioritize patient safety in state scope of practice actions

ASA Opposition to Medicare Chronic Pain Rule

Patient Protection and Affordable Care Act (PPACA)

ASA commends the inclusion of key elements of the National Pain Care Policy Act in section 4305 of PPACA. First, PPACA required the Secretary of Health and Human Services (HHS) to enter into an agreement with the Institute of Medicine (IOM) to convene a Conference on Pain. Accordingly, in June 2011 IOM released a report in which it summarized its findings and recommendations, entitled, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Second, PPACA created the Interagency Pain Research Coordinating Committee (IPRCC) to coordinate all efforts related to pain research within HHS and other federal agencies. Third, PPACA permits the HHS Secretary to make grants for programs that provide training and education to health care professionals in pain care. Congress has not yet appropriated funds for these grants.

View the text of section 4305.

Essential Health Benefits

In December 2011, the Centers for Medicare and Medicaid Services (CMS) released an Essential Health Benefits Bulletin (Bulletin), which set forth CMS’s proposed approach to defining an Essential Health Benefits (EHB) package under PPACA.  Non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges, as well as Medicaid benchmark plans, must cover EHB beginning in 2014.  According to the Bulletin, CMS intends to propose that each state pick a benchmark plan among certain plans currently offered in the state, and the benefits and services included in the benchmark plan would be the EHB package.  EHB must include coverage of ten mandated benefit categories identified in PPACA (ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness screenings and chronic disease management, and pediatric services).  The benchmark plan will serve as a reference plan, and health insurance issuers in the state must offer benefits “substantially equal” to the benefit package offered by the benchmark plan. 

In response to the Bulletin, the Pain Care Coalition, which includes the American Society of Anesthesiologists, submitted a comment letter urging CMS to include the assessment, diagnosis, treatment and management of a patient’s acute or chronic pain in the EHB package. 

Institute of Medicine (IOM) Report on Pain

In June 2011, IOM released a report, entitled, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The report assessed the current state of the science of pain research, care, and education, and made numerous recommendations that the authors believe would advance the field of pain medicine. These recommendations focused on data collection, patient care, education, and research.

The report found that at least 100 million U.S. adults suffer from common chronic pain, and the annual cost of chronic pain in the United States is estimated to be a staggering $560-635 billion in direct medical treatment costs and lost productivity. The report claimed that there is not enough consistent data to determine the incidence and prevalence of pain, and recommends that federal and state agencies and private organizations collect data on pain through surveys and electronic health records. The report also recommends that patients receive the majority of care and management through self-management and primary care, while specialists focus on more complex cases. In addition, the federal government and relevant stakeholders should develop education programs for patients, the public, and health care providers to address gaps in knowledge about pain. Finally, the report advocates for one of the existing NIH institutes to be the lead institute for pain. NIH should also broaden the scope of the NIH Pain Consortium and increase its financial resources and staffing support. The report also calls for improvement of the process for developing new agents for controlling pain, as well as increased support for interdisciplinary and longitudinal research in pain and training of pain researchers.

Read the report.

02/14/12: ASA Addresses Key Findings and Recommendations of IOM Pain Report to Senate HELP Committee

02/09/12: Pain Care Coalition Urges Senators to Attend Heading on IOM Pain Report

10/11/11: ASA Urges Senate Committee to Hold Hearing on IOM Pain Report

E-Prescribing (eRx) Incentive Program

Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized the Secretary of Health and Human Services (HHS) to establish an Electronic Prescribing (eRx) Incentive Program. The eRx Incentive Program, implemented in 2009, offers financial incentives to eligible professionals who are successful electronic prescribers.

Learn more about the eRx Incentive Program and how to apply for a hardship exemption:

2013 hardship exemption.

2012 hardship exemption.

09/06/11: CMS Final Rule on Changes to the Electronic Prescribing Incentive Program

08/30/11: ASA Urges for Exemptions in Comment Letter on Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2012

ASA Nomination Letters

ASA Nomination of Dr. Asokumar Buvanendran to Interagency Pain Research Coordinating Committee

ASA Nomination of Dr. Gregory Brenner to Interagency Pain Research Coordinating Committee

ASA Nomination of Dr. Kieran Slevin to Interagency Pain Research Coordinating Committee workgroup creating a strategy in pain care, as recommended by the IOM report, Relieving Pain in America.

ASA Nomination of Dr. James Rathmell to IOM Committee on Pain

ASA Nomination of Dr. Richard Rosenquist to the Interagency Pain Research Coordinating Committee

Payment Issues

HHS Office of Inspector General (OIG) Work Plans

OIG Reports

Please note that CPT codes and reporting instructions have been revised since OIG issued the reports below. To ensure correct and compliant coding, always use the codes and guidance in effect on the date services are provided.

Transforaminal Epidural injection Services (August 2010)

Facet Joint Injection Services (September 2008)

Medicare Coverage Database: The Medicare Coverage Database contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). The database also contains local articles, proposed NCDs and other national coverage policy-related documents.

Reuse of Single Dose Vials

The Centers for Disease Control and Prevention (CDC) July 13 Morbidity and Mortality Weekly Report (MMWR) reminded health care professionals of the serious consequences of using a single dose vial (SDV) for multiple patients even when they believe they have taken necessary precautions. According to CDC,

"This report summarizes the investigation of two outbreaks of inva­sive Staphylococcus aureus infection confirmed in 10 patients being treated for pain in outpatient clinics. In each outbreak, the use of single-dose or single-use vials (SDVs) for more than one patient was associated with infection transmission. In both investigations, clinicians reported difficulty obtaining the medication type or vial size that best fit their procedural needs. These outbreaks are a reminder of the serious consequences that can result when SDVs are used for more than one patient. Clinician adherence to safe injection practices, particularly when appropriately sized SDVs are unavailable, is important to prevent infection transmission. If SDVs must be used for more than one patient, full adherence to U.S. Pharmacopeia standards is critical to minimize the risks of multipatient use."

Specifically, the repackaging of medications from a previously unopened SDV should only be performed using a laminar-flow hood in accordance U.S. Pharmacopeia General Chapter 797.

ASA supports CDC’s position, and adopted CDC’s Safe Injection Practices in the Recommendations for Infection Control for the Practice of Anesthesiology (3d ed.). ASA has also worked with the International Spine Intervention Society (ISIS) in reviewing policies on the use of SDV for multiple patients. ISIS President, Ray Baker, M.D., issued a statement on safe injection practices. Dr. Baker explains that ISIS "thoroughly reviewed nine documented outbreaks involving pain clinics, including five unpublished reports," and concluded that "the use of SDVs for multiple patients has causally contributed to infectious disease outbreaks from interventional pain procedures, resulting in severe morbidity and even mortality."