The NOPAIN Act officially went into effect in January 2025, and it’s already changing the landscape of post-operative care. For ambulatory surgery centers (ASCs), hospitals, and healthcare administrators, this legislation presents a critical opportunity for improving patient outcomes and optimizing billing processes in a rapidly shifting environment.
Compression Solutions has covered this topic before, but as we start to see real implementation play out, we want to share what we’re learning and why this moment matters.
In short: Reviewing your billing process right now could set you up for long-term efficiency and success.
Don’t Miss the Moment: NOPAIN Act Billing Opportunities
In the early months after the NOPAIN Act, we’re already seeing favorable reimbursements.
In our experience, this higher ROI is often the case immediately following new legislation like this. However, as CMS adjusts rates based on real-world claims and utilization data, these reimbursements could go down. Reimbursement rates up to $2,284.98 for the disposable ambIT Electronic Infusion Pump devices could be possible.
Remember that these reimbursements through the NOPAIN Act are also only a temporary Medicare mechanism for qualifying non-opioid pain management treatments. The provision is set to remain in effect through December 31, 2027.
This type of C code billing isn’t new. Programs like this have been utilized since 1999 under section 201 of the Balanced Budget Refinement Act.
While temporary, these new reimbursement options are aligned with the government’s long-term emphasis on non-opioid pain management options. Reimbursements in 2028 and beyond will require additional legislative action, however. They will no longer utilize “pass-through” C codes and will need to find a more permanent home within the CMS ecosystem.
Questions about NOPAIN Act billing? Contact your local rep for further information.
NOPAIN Act + Medical Billing Services = Optimal Cash Flow
Pain pump reimbursements now take two forms:
Medicare
Medicare Claims must be submitted by facilities themselves under the new temporary HCPCS C codes defined by the NOPAIN Act. These codes are only billable in the outpatient hospital or ASC setting and must be included on the facility’s UB-04 claim form. They are not eligible under Medicare Part B or the physician fee schedule.
Commercial Insurance
Commercial payers will still cover pain pumps, but they often don’t allow facilities to bill for the devices directly. Additionally, facilities may be contractually restricted in how they bill for devices or disposable components.
Compression Solutions can bill commercial payers directly as a DME provider in many cases, which can offload costs through streamlined processes.
Commercial reimbursement processes also vary widely, but CSI understands these payer-specific nuances. Our team has decades of experience, and we’ve built a system that’s efficient, integrated, and patient-focused.
Compression Solutions will continue to manage commercial billing for the foreseeable future, but now that Medicare reimbursements are available through the NOPAIN Act, facilities can take advantage of both sides to build a potentially cost-neutral program for pain management devices.
“Compression Solutions’ billing services are working hand-in-hand with the NOPAIN Act. Our billing expertise can provide guidance to optimize your program on both the commercial and Medicare sides.” – Brian Stowell, National Programs Manager
Efficiencies With a Medical Billing Partner You Can Trust
CSI’s commercial billing process enables facilities to offset costs associated with a post-operative pain management program.
From verifying patient benefits to working directly within your EMR system, our expert team helps ensure accuracy in billing.
Further Reading: How Submitting Digital Documentation Saves Time & Money
Partner with CSI
Have questions about NOPAIN Act billing?
Looking to build a truly cost-neutral program for pain pump devices?
Let’s talk about how we can help you reduce errors, improve turnaround times, and unlock new efficiencies in your billing process.
Get ambIT for Your Facility
Equip your hospital or surgery center with ambIT pain pump devices, including convenient medical billing and customer support when you order through Compression Solutions.
