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CMS Comparative Billing Report on Pain Management Services

​March 20, 2012

On March 20, 2012, The Centers for Medicare & Medicaid Services (CMS) and its contractor, SafeGuard Services LLC (SGS) will be faxing or mailing a comparative billing report (CBR) on Pain Management Services to some of you. A CBR is a documented analysis that shows a provider's billing pattern for various procedures or services and compares that billing to their peers.  CBRs are sent to a maximum of 5,000 health care providers per topic, so not every physiatrist will receive such a report.

The Academy has been assured by CMS and its contractor, SGS, that the CBR is not intended to be punitive or sent as an indication of fraud. Rather it is intended to be a proactive statement that will help the provider identify potential errors in their billing practice.  CMS and its carriers realize that procedures may, in fact, be reported within guidelines and local coverage determinations.  This is meant to be a tool for conversation within your respective practice.

The analyses for this CBR are based on Medicare final claims data, with service dates from October 1, 2010 through September 30, 2011, retrieved from the Integrated Data Repository on February 7, 2012. Claim lines selected have covered charge amounts greater than zero, were performed in an office setting, have a provider specialty of Anesthesiology (Specialty 05), Interventional Pain Management (Specialty 09), Physical Medicine and Rehabilitation (Specialty 25), or Pain Management (Specialty 72).  

The utilization measures analyzed in this CBR are the average number of services rendered per beneficiary for the following 10 CPT codes/groupings listed below.

  • Epidural injections-cervical or thoracic (64479, 64480)
  • Epidural injections-lumbar or sacral (64483, 64484)
  • Facet injections- cervical or thoracic (64490, 64491, 64492)
  • Facet injections-lumbar or sacral (64493, 64494, 64495)

Measures are statistically compared to the average of your specialty and national peers. The results are displayed in graphs and tables.

Below are links for a sample report and a list of frequently asked questions for your information.  If you receive a CBR, please direct all questions on the CBR content or any suggestions to the CBR Producer at (530) 896-7080. For additional information, see www.cbrservices.com.