CMS Pub. 100-03, ch. 1, § 10.4

Some hospitals also provide pain rehabilitation programs for outpatients. In such

programs, services frequently are provided in group settings even though they are being

furnished pursuant to each patient’s individualized plan of treatment.

Coverage of services furnished under outpatient hospital pain rehabilitation programs,

including services furnished in group settings under individualized plans of treatment, is

available if the patient’s pain is attributable to a physical cause, the usual methods of

treatment have not been successful in alleviating it, and a significant loss of ability by the

patient to function independently has resulted from the pain. If a patient meets these

conditions and the program provides services of the types discussed in §10.3, the services

provided under the program may be covered. Non-covered services (e.g., vocational

counseling, meals for outpatients, or acupuncture) continue to be excluded from

coverage, and A/B MACs would not be precluded from finding, in the case of particular

patients, that the pain rehabilitation program is not reasonable and necessary under

§1862(a)(1) of the Social Security Act for the treatment of their conditions.