Section 20-2-XI - CHRONIC PAIN - INTER-DISCIPLINARY PAIN REHABILITATION PROGRAMA. The Inter-Disciplinary Pain Rehabilitation (IDPR) program is based on the bio-psychosocial approach to managing chronic pain, and uses both physical medicine treatments as well as psychological treatments and therapy to manage the chronic pain patient. A goal oriented, team approach is used in an effort to reduce pain, improve functioning, and decrease the dependence on the health care system of persons with chronic pain. This is an outpatient program.B. Authorization/pre-certification is required in order to utilize an inter-disciplinary pain rehabilitation program to treat the chronic pain patient. A specific IDPR program plan must be submitted to the payer as part of the authorization/pre-certification process.C. The following guidelines shall be used to assist in pre-certification, and concurrent review: 1. Persons considered suitable candidates for an inter-disciplinary pain rehabilitation program are those: a. Who are likely to benefit from the program design;b. Whose symptoms are deemed by a pain management provider to constitute chronic pain syndrome; and c. Whose medical, psychological, or other conditions do not prohibit participation in this program.2. Mental Health Evaluation: an initial evaluation to determine the injured worker's readiness or suitability for this type of treatment may be performed prior to initiation of treatment. This evaluation is not considered part of the IDPR program and shall be billed separately.3. Due to the nature of intensity of the program, both group and individual therapy may be part of the IDPR program. If the program plan for a particular patient includes individual psychotherapy, it shall be billed as part of the program, and not separately. If the program does not include psychotherapy services, such services may be billed separately, if used, subject to applicable pre-authorization requirements.4. Psychological treatments which are part of the IDPR program may be rendered by a psychiatrist, psychologist, licensed counselor, or licensed social worker. 5. The IDPR program shall always include a component designed to reduce the patient's dependence on and/or addiction to pain medications.6. An individual plan of treatment shall be supervised by a medical doctor within a therapeutic environment. Although some time is spent with a doctor on a one-to-one basis, more than fifty percent (50%) of the time may be spent in direct care under the supervision of the physical therapist, occupational therapist, mental health provider, or other licensed member of the IDPR team.7. Program supervision shall be provided by a medical doctor who is trained and experienced in the treatment of patients with chronic pain syndrome. The program supervisor shall: a. Provide direct, on-site supervision of the daily pain management activities;b. Participate in the initial and final evaluation of the patient;c. Write the treatment plan for the patient, and write changes to the plan based on the patient's documented response to the treatment and/or based on documented changes in the patient's condition; andd. Direct the members of the IDPR team and review the patient's progress on a regular and consistent basis, at least bi-weekly.8. Participation in an IDPR program requires a minimum attendance of four (4) hours per day during the first week. The program shall not exceed eight (8) hours per day, except that workers who actually have experience working in a job for more than eight (8) hours per day may be allowed to participate for up to ten (10) hours per day, at the discretion of the program supervisor 9. Daily treatment and patient response shall be documented and provided to the payer at least every two (2) weeks.10. Discharge/exit criteria shall include but not be limited to: a. The appropriate use of medications;b. Decreased intensity of subjective pain;c. Increased ability of the injured worker to manage pain;d. Reduced health care use related to the chronic pain;e. Return to work; and/orf. Non-compliance with the program, or failure to obtain meaningful benefit after a reasonable period of time. D.Billing. The IDPR program shall be billed using CPT 97799 - Unlisted physical medicine/rehabilitation service or procedure, and appended with modifier M5 to indicate chronic pain treatment. The total number of hours shall be indicated in the units column of the bill, or in some other conspicuous place on the bill. CARF accredited providers shall also add M4 as an additional modifier.E.Reimbursement. Reimbursement shall be as agreed to by the parties, or a maximum of one hundred dollars ($100.00) per hour for CARF accredited providers. Providers without CARF accreditation shall be paid eighty percent (80%) of the maximum reimbursement allowance for CARF accredited providers. Units of less than one hour shall be prorated in fifteen (15) minute increments. A single fifteen (15) minute increment shall be reimbursed if the time is equal to or greater than eight (8) minutes and less than twenty-three (23) minutes.