Pain Management Program Offerings

Dr. Newton’s practice can implement four comprehensive pain management programs, each combining conservative treatments with billable services and retail items. These programs prioritize regulatory compliance and evidence-based therapies, using appropriate ICD-10 diagnostic codes and CPT/HCPCS billing codes for in-office services. Below is a summary of each program:

OA and Joint Pain Program (Knee Osteoarthritis and Joint Pain)

This program targets osteoarthritis (OA) and related joint pain, particularly in the knees. It integrates knee bracing, therapeutic joint injections, and physical therapy to improve joint function and reduce pain. Key components include:

• Unloader Knee Bracing: Medial/lateral unloader knee braces relieve pressure on arthritic compartments. For example, an off-the-shelf OA knee brace (HCPCS L1851) or custom-fitted brace (HCPCS L1843) can be providedossur.com. These braces are considered conservative OA management to delay surgeryossur.com. Braces are dispensed with proper documentation and side modifiers (LT/RT) as requiredossur.com. ICD-10 codes: use OA diagnoses such as M17.0 – Bilateral primary osteoarthritis of knee (for both knees) or M17.11/M17.12 for unilateral knee OA. CPT/HCPCS codes: L1851 (knee orthosis, OTS) or L1843 (custom knee brace) for billing the braceossur.com. A suspension sleeve (HCPCS L2397) may be added if medically necessary (e.g. for edema or skin protection)ossur.com.
  
  

• Joint Injections (Viscosupplementation or Steroids): Intra-articular injections provide pain relief and improved mobility. Hyaluronic acid viscosupplementation, often given as a series of weekly knee injections, is FDA-approved for knee OA and covered by Medicare with proper indicationsprogressusrevenue.comprogressusrevenue.com. Corticosteroid injections are another option for acute inflammation. CPT codes: 20610 (injection/aspiration of a major joint, without imaging) or 20611 (with ultrasound guidance) per kneecms.gov. These codes are used for injecting viscosupplements or steroids into the knee joint (the drug supply is billed separately via J-codes)cms.gov. Only one unit of 20610/20611 is billed per knee, with a -LT or -RT modifier (or -50 for bilateral) when applicablecms.gov. ICD-10 codes: use codes for knee pain or OA (e.g., M25.561 – Pain in right knee) in addition to the OA diagnosis to justify injections. Documentation should show conservative measures (NSAIDs, exercise) were tried for 3+ months prior, per Medicare guidelinescms.govcms.gov.
  
  

• Physical Therapy and Range-of-Motion Exercise: Patients are prescribed physical therapy to improve range of motion and strengthen supporting musculature. Therapists can bill codes like 97110 (therapeutic exercise) or 97140 (manual therapy) for these sessions. While PT is typically billed by the therapy provider, the physician can coordinate it as part of the program. Emphasizing home exercise compliance is key. ICD-10 codes for stiffness or reduced mobility (e.g., M25.60 – Stiffness of unspecified joint) may be documented if relevant.
  
  

Office Package Recommendations: Many clinics successfully offer bundled OA treatment packages. Popular bracing/injection bundles include:

• “OA Knee Relief Bundle 1” – A medial unloader knee brace combined with a series of hyaluronic acid injections (e.g. 3–5 weekly injections)progressusrevenue.com. This bundle addresses biomechanical unloading and joint lubrication. It can be billed via L1851 for the brace and 20610 + J-codes for each injection.
  
  

• “OA Knee Relief Bundle 2” – A hinged support knee brace plus a corticosteroid injection for flare-ups, followed by supervised exercise therapy. The steroid injection (20610) provides quick pain reduction, while the brace (L1851/L1843) and exercises help long-term stability.
  
  

• “Advanced Knee OA Package” – An unloading brace with an injectable PRP or biologic (if offered, using CPT 0232T for PRP injection) along with physical therapy sessions. (Note: PRP for knee OA is non-covered by Medicare; patient consent and compliance with state regulations are required).
  
  

These bundles can be marketed as cash packages or billed to insurance as applicable. Proper documentation of medical necessity (e.g. pain scales, functional limits, x-ray confirmation of OA) is crucial for reimbursementcms.gov. Overall, the OA program is a non-surgical, multimodal approach to relieve joint pain and improve mobility, in line with payers’ preference for conservative management before considering surgeryossur.com.

Back Pain and Sciatica Program

This program addresses chronic low back pain, disc herniation, and sciatica with a combination of lumbar bracing, spinal injections, and exercise therapy. The goal is to reduce pain, stabilize the spine, and improve function without opioids. Key elements:

• Lumbar Support Bracing: A lumbar-sacral orthosis (LSO) helps support the lower spine and limit painful motion. For example, an Aspen Horizon 637 LSO (classified under HCPCS L0637) provides rigid anterior and posterior panels for sagittal and coronal controlcoretechortho.com. Code L0637 is defined as “Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior panels, extends from sacrococcygeal junction to T9”coretechortho.com, and is used for custom-fit braces that offer substantial support. Such braces (L0637 or similar L0650 code) can be dispensed in-office to patients with lumbar instability, degenerative disc disease, or postural issues. ICD-10 codes: common diagnoses include M54.50 – Low back pain, unspecified and M54.31 – Sciatica, right side (or M54.32 left side) for radiating painwebpt.com. Lumbar disc disorders can be coded with M51.26 – Lumbar intervertebral disc displacement or M51.16 – Disc disorder with radiculopathy for herniated discs with nerve symptoms. These diagnoses justify the medical need for bracing. HCPCS code: L0637 (prefabricated LSO brace) with appropriate modifiers (LT/RT if needed for hip orientation) is billed when providing the brace. Ensure a proper fit and patient instruction on use, documented in the chart.
  
  

• Spinal Injections for Pain Relief: Interventional pain procedures like epidural steroid injections (ESIs) or nerve blocks are offered to reduce inflammation around nerves. For sciatica due to disc herniation, a lumbar epidural steroid injection can alleviate leg pain. CPT codes: 62323 (lumbar epidural injection, with imaging guidance) or 64483 (transforaminal epidural injection, single lumbar level) are typically used for these procedurescms.gov. These codes correspond to lumbar/sacral spinal region injections for pain managementcms.gov. Facet joint injections (CPT 64493 for lumbar facet) or sacroiliac joint injections (CPT 27096) may also be utilized if indicated. ICD-10 codes: match the injection to the diagnosis, e.g. M54.16 – Radiculopathy, lumbar region for nerve root pain or the disc disorder codes above. Each injection requires documentation of imaging-confirmed pathology and that conservative measures (rest, meds, therapy) were tried. Fluoroscopic or ultrasound guidance should be used for accuracy (and billed if separate, e.g., CPT 77003 for fluoroscopy if not inherent to the code).
  
  

• Home Exercise and Therapy: Patients are coached in a home-based exercise regimen focusing on core strengthening, flexibility, and proper body mechanics. The clinic can provide illustrated exercise plans or refer to physical therapy. Education on posture, ergonomic modifications, and stretching is included. While home exercise is not directly billable, if the practice has physical therapy services, 97110 (therapeutic exercise) and 97530 (therapeutic activities) codes can be billed for supervised sessions teaching these exercises. Regular follow-up visits (E/M codes 99213+) monitor progress and adherence. ICD-10: document functional limitations (e.g., Z91.19 – Patient’s noncompliance [if issues adhering], or simply continue the back pain code) and improvements over time.
  
  

Billing and Package Tips: A comprehensive back pain program can be structured as a package (e.g., “Lumbar Care Program”) combining a one-time brace dispense, a set number of injection sessions, and an exercise guidance component. Offices often bundle a prefabricated LSO brace plus one ESI as an initial package, then add follow-up therapy visits as needed. Each service is billed separately to insurance with the codes above, but presenting it to patients as a coordinated program improves buy-in. Ensure all services are within scope (e.g., injections by a qualified provider) and pre-authorize injections when required. Patient education on proper brace use and gradual exercise escalation is provided to maximize outcomes. Common diagnoses like lumbago (M54.50) and sciatica (M54.3-) support the medical necessity of these interventions. By providing bracing, interventional pain relief, and rehab, this program offers a multimodal alternative to relying on opioid medications for chronic back pain.

Neuropathy Program (Nerve Regeneration and Support)

This program is designed for patients with peripheral neuropathy – for example, diabetic neuropathy or idiopathic neuropathy causing numbness, tingling, or burning pain in the feet and hands. The focus is on nerve regeneration and symptom relief through nutraceutical support and adjunct therapies, offered in a compliant manner. Key aspects:

• Nutraceutical Nerve Regeneration Supplements: The program centers on offering specialized supplement regimens that may promote nerve health. Dr. Newton’s office can retail these supplements directly, providing a new revenue stream and convenient access for patients. Three effective supplement programs often used are:
  
  

  • NGX Nerve Health Solution (Neurogenx®): A proprietary supplement blend based on the Nobel Prize-winning research on nitric oxide (NO)neurogenx.com. This powder formula combines L-arginine and L-citrulline to boost the body’s NO production, thereby improving circulation to nerve endingsneurogenx.com. Better blood flow and nutrient delivery can aid in nerve repair. The Neurogenx supplement also includes antioxidants and is available in multiple flavors. It has reported benefits of decreased neuropathic pain/numbness and increased sensation in extremitiesneurogenx.com. NGX is sold wholesale to healthcare providers and can only be purchased through a clinic (not over-the-counter)neurogenx.comneurogenx.com, making it an ideal in-office product. Usage guidance: Patients mix the supplement daily; results are expected after 30–60 days of consistent useneurogenx.com. The clinic must counsel patients that this is a dietary supplement, not an FDA-approved drug, and thus no definitive cure claims are madeneurogenx.com. Documentation can use a code like Z79.899 – Other long term drug therapy to note ongoing supplement use (though not required).
    
    

  • Metanx® (L-Methylfolate/B6/B12 combination): A prescription medical food indicated for the dietary management of peripheral neuropathy, especially diabetic neuropathyen.wikipedia.org. Metanx contains high doses of L-methylfolate (active folate), Pyridoxal-5-phosphate (B6), and Methylcobalamin (B12)en.wikipedia.org. These B vitamins address nutritional deficiencies that contribute to neuropathy and support endothelial health for nerve repairpmc.ncbi.nlm.nih.gov. Clinical studies have shown Metanx can improve neuropathic symptoms (like numbness, paresthesias) and even help with diabetic foot ulcer healingen.wikipedia.org. As a medical food, it is “prescribed” and often dispensed through specialty pharmacy, but some practices keep stock to sell directly to patients. Usage guidance: Typically 1 capsule twice daily. Patients should understand this treats the nutritional aspect of neuropathy and may take several months to notice improvementzennutrients.comzennutrients.com. It is a safe adjunct to other therapies.
    
    

  • NeuraZenX™ (Zen Nutrients) or Comparable High-Dose ALA Formula: NeuraZenX is an OTC supplement formulated by physicians as a comprehensive nerve support formula. It contains over 20 ingredients, notably 1200 mg of Alpha-Lipoic Acid (ALA) per serving along with benfotiamine (a form of vitamin B1), acetyl-L-carnitine, turmeric, and other neuroprotective herbszennutrients.com. ALA is an antioxidant shown to improve blood flow to nerves and reduce neuropathic pain, especially in diabetic neuropathy, at doses of 600–1200 mg daily. Many competing products (e.g. Nerve Renew, Nervive Nerve Relief) have lower doses (300–600 mg), which may be less effectivezennutrients.com. NeuraZenX distinguishes itself with higher potency and pharmaceutical-grade ingredientszennutrients.com. Usage guidance: Start 2 capsules daily and increase to twice daily (total 4 caps) after one weekzennutrients.com. Consistent use for at least 3 months is recommended to allow nerve fiber regenerationzennutrients.com. Patients should be advised to report any new symptoms (ALA can rarely upset glucose control or cause GI upset) and clinicians should monitor progress.
    
    

• These supplements are complementary therapies aimed at nerve health. It’s important to provide compliant guidance: inform patients that while many experience symptom relief, these products are not FDA-approved medications for disease treatmentneurogenx.com and results can vary. Document the recommendation in the chart (e.g. “Started NGX supplement for neuropathy”) and monitor neuropathy scores (e.g. neuropathic pain scale) at follow-ups to justify continued use.
  
  

• Clinical Monitoring and Adjunct Therapies: The neuropathy program can include periodic evaluations to track improvement in sensation and pain (bill E/M codes for these visits). ICD-10 codes: use G62.9 – Polyneuropathy, unspecified for general peripheral neuropathy, or specific ones like E11.40 – Type 2 diabetes with neuropathy for diabetic patients, as the primary diagnosis. These codes validate the necessity of the neuropathy-focused interventions. While supplements themselves don’t have CPT codes (they are patient-pay items), if the clinic provides other services – e.g., nerve conduction studies to assess neuropathy (CPT 95910/95911) or electrical stimulation therapy for neuropathic pain (CPT 97014 or HCPCS G0283) – those can be billed separately. Some practices also employ specialized devices such as the Neurogenx electroanalgesia device; treatments with such a device would be billed under appropriate PT/untimed codes or unlisted codes as per guidance.
  
  

• Compliance and Patient Education: Patients are educated on foot care, injury prevention (since neuropathy impairs sensation), and lifestyle factors (like tight blood glucose control for diabetics, vitamin intake, and exercise to improve circulation). The program stays within legal and ethical bounds by not making unfounded claims: marketing materials use language like “supports nerve regeneration” rather than “cures neuropathy.” The office should keep MSDS and supplement facts on file and ensure products have third-party testing for qualityzennutrients.com. By selling reputable supplements in-office, Dr. Newton’s practice offers patients convenience and guidance, which can improve adherence. Regular follow-ups (perhaps every 4–6 weeks) to adjust the program are advisable. If no improvement after a few months, consider referral to a neurologist or adding medications (e.g. gabapentin) per standard of care.
  
  

Opioid Alternative & Mental Health Education Program

This program provides alternatives to opioid analgesics for chronic pain management, along with patient education on coping strategies and mental health. It is especially relevant amid the opioid crisis, focusing on safe pain relief modalities such as medical cannabis (where legal), non-opioid medications, and psychosocial support. All recommendations comply with current state/federal laws and medical guidelines. Key components include:

• Medical Cannabis Recommendations (Where Permitted): In states that allow medical marijuana, Dr. Newton can evaluate patients for cannabis as a pain management adjunct. Medical cannabis may benefit certain chronic pain patients, particularly those with neuropathic paincdc.gov. The program includes a cannabis consultation and certification process following state regulations – typically verifying a qualifying condition (e.g. chronic pain, neuropathy, PTSD, etc.), discussing risks/benefits, and registering the patient with the state’s medical cannabis program if they are eligible. ICD-10 codes: use the primary pain diagnosis (e.g., G89.29 – Other chronic pain or specific pain syndrome codes) as the reason for cannabis therapy, rather than coding cannabis use disorder (since this is a therapeutic use, not abuse). Also consider Z63.1 – Appropriate counseling codes if available (e.g., Z71.89 for “Other specified counseling” might be used to denote counseling on cannabis use). CPT codes: There is no special CPT for a cannabis consult; it is typically billed as an Evaluation & Management visit (e.g., 99213 for established patients) with documentation of the counseling provided. Time-based coding can be used if counseling takes the majority of the visit. The physician must have the proper state certification to recommend cannabis and must abide by any quantity limits and follow-up requirements mandated by state law. Compliance notes: The program emphasizes that cannabis is not a first-line therapy and that evidence for its efficacy in pain is limitedcdc.govcdc.gov. Patients are warned that cannabinoids can have side effects and variable potency; indeed, cannabis “may not be safer than other medications and often has side effects”madeforthismoment.asahq.org such as sedation or cognitive changes. The program advises against concomitant opioid and cannabis misuse (combining them can increase overdose risk)cdc.gov. All advice given is within legal frameworks: for example, advising on CBD oil (legal federally if <0.3% THC) versus THC products (which require state program enrollment). No cannabis product is supplied by the clinic – only recommendations are given, and patients obtain the product from licensed dispensaries. The patient education also covers proper dosing (e.g., “start low, go slow” with THC), and the importance of not driving under the influence.
  
  

• Non-Opioid Pharmacologic Alternatives: The program offers a range of non-opioid medications and therapies to manage chronic pain. Patients are evaluated for appropriate analgesics such as NSAIDs (e.g. naproxen, ibuprofen) or acetaminophen as first-line optionsmadeforthismoment.asahq.orgmadeforthismoment.asahq.org. Adjuvant pain medications are utilized based on pain type: for neuropathic pain, anticonvulsants (gabapentin, pregabalin) or SNRIs/tricyclics (duloxetine, amitriptyline) can be prescribed; for musculoskeletal pain, muscle relaxants or topical analgesics (lidocaine, diclofenac gel) may be used. The program might also include interventional procedures (as detailed in the other programs) like nerve blocks, trigger point injections, or radiofrequency ablation to reduce reliance on systemic drugsmadeforthismoment.asahq.orgmadeforthismoment.asahq.org. ICD-10 codes: use the chronic pain diagnosis or specific condition (e.g., M79.2 – Neuralgia/neuritis NOS for nerve pain) to justify these prescriptions. CPT codes: When providing focused drug counseling, consider CPT 99408 for a 15-30 min substance abuse preventive counseling session (though typically for alcohol/drug abuse prevention, it can be repurposed for extensive opioid-alternative counseling)icd10data.com. However, most often the management of non-opioid meds is part of routine E/M visits. If the program includes dispensing certain items (e.g., TENS units for home use), those have HCPCS codes (E0730 for a TENS device) and can be billed if the practice supplies them. Overall, this component ensures that every patient has an individualized pain management plan leveraging medications with lower risk profiles than opioidsmadeforthismoment.asahq.org. Patients who are already on opioids may be gradually tapered under medical supervision while these alternatives are introduced, in line with CDC guidelines.
  
  

• Mental Health and Pain Coping Education: Chronic pain often intertwines with mental health challenges like anxiety, depression, and maladaptive coping. Thus, a key part of the program is patient education and mental health support. This may involve counseling sessions focused on pain coping strategies – for example, training in cognitive-behavioral therapy (CBT) techniques, relaxation methods, meditation, or biofeedback. If the practice has a behavioral health specialist, psychotherapy can be provided (CPT 90832–90837 series for therapy sessions, with diagnosis codes like F45.42 – Pain disorder with related psychological factors if applicable). For general patient education delivered by clinical staff, the clinic can use CPT 98960 (educational session, 30 min, individual) or 98961 (group education, 2-4 patients) to bill for structured self-management trainingaapc.comgawendaseminars.com. For example, a nurse or counselor might lead a pain management class covering topics such as pacing of activities, stress management, and cognitive techniques to cope with flare-ups. ICD-10: Z71.89 – Other specified counseling is a useful code to capture an encounter for pain management counseling or health educationicd10data.com. Additionally, if addressing opioid avoidance or tapering, Z71.51 – Drug abuse counseling can be used when counseling a patient on avoiding dependenceicd10data.com (even if the patient is not an abuser, this code covers counseling on drug use). All educational content is kept within scope of practice – for instance, discussing the importance of sleep, referring to mental health professionals for severe depression, and encouraging use of support groups. The program might also coordinate with pain psychologists or group therapy programs in the community. Documentation should reflect the time spent and topics covered (important if time-based codes or higher-level E/M services are billed due to counseling).
  
  

Regulatory Compliance: This Opioid Alternative program is careful to align with legal requirements. For example, if discussing medical cannabis, the provider verifies that the patient’s state ID and certification are in place and does not provide any product across state lines (federal law considerations). The clinic also stays updated on DEA and state board guidelines for opioid prescribing – if an opioid taper is done, a proper controlled substance agreement and ICD-10 code for opioid use (e.g., Z79.891 – Long-term use of opiate analgesic) might be documented. No controlled substances are promoted in this program beyond possibly buprenorphine for dependence if needed (which would be managed under a separate MAT program). The emphasis is on demonstrating that effective pain relief can be achieved through multimodal therapy rather than opioids, thereby improving patient safety and compliance with public health recommendations. According to the CDC, more research is needed on cannabis for pain, and it should not be considered a proven replacement for opioidscdc.gov. The program communicates this nuance to patients, presenting cannabis or CBD as one option among many, rather than a cure-all. By educating patients on realistic expectations, side effect profiles, and proper use of alternatives, Dr. Newton’s practice can reduce opioid reliance while still addressing chronic pain holistically.

Billing Codes Summary: To summarize some relevant codes across this program: ICD-10 codes commonly used include G89.4 (Chronic pain syndrome), G89.29 (Other chronic pain), F11.90 (Opioid use disorder, if addressing dependence), Z71.89 (counseling session for pain/other), and others tailored to each patient’s situation. CPT/HCPCS codes include standard E/M visit codes for ongoing management; 99408/99409 for substance use intervention counseling if extensiveicd10data.com; 98960 for educational sessionsaapc.com; and codes for any interventional procedures or DME provided (as described in prior programs). All services are billed with appropriate modifiers and documentation to ensure compliance. The practice may also track outcomes (pain scores, functional assessments) as part of quality improvement and to support the medical necessity of this comprehensive approach.

Each of these programs offers Dr. Newton a path to improve patient outcomes while generating revenue through services and products that are covered by insurance or sold in-office. By using proper coding and maintaining medical necessity documentation, the clinic can remain compliant with billing regulations. Moreover, by prioritizing safe, multi-modal pain management over opioids alone, these programs align with current best practices and legal guidelinesmadeforthismoment.asahq.orgcdc.gov. Patients benefit from a more holistic approach to pain, involving physical supports, targeted injections, nutritional therapy, and education – all of which can be delivered or coordinated through Dr. Newton’s medical offices across the United States. The tone of these offerings remains professional and medically appropriate, ensuring that patients receive effective pain relief in a safe and legally compliant manner.

Sources: Connected sources detailing brace and injection coding, supplement programs, and non-opioid pain management have been cited inline (【32】【36】【42】【43】【17】【49】【22】【29】【30】【31】 and others). These provide further reading and evidence for the approaches summarized above.