Medicare Adds Pulmonary Rehab as Covered Benefit

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  • May 14, 2010
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The Medicare Improvements for Providers and Patients Act of 2008 (MIPPA) provides a covered benefit for a physician-supervised comprehensive pulmonary rehabilitation (PR) program under Medicare Part B, effective Jan. 1 for claims processed on or after Oct. 4.

PR is a multi-disciplinary program of care that is individually tailored and designed to optimize physical and social performance and autonomy and an evidence-based, multi-disciplinary, and comprehensive intervention.
When referred by the treating physician, Medicare will cover PR items and services for patients with moderate chronic obstructive pulmonary disease (COPD) who are symptomatic and who may have decreased daily life activities.
Required components of a PR program include:

  1. physician-prescribed exercise;
  2. education or training;
  3. psychosocial assessment;
  4. outcomes assessment; and
  5. an individualized treatment plan.

PR program sessions are limited to a maximum of two 1-hour sessions per day for up to 36 sessions, with the option for an additional 36 sessions if medically necessary.
Report PR items and services with HCPCS Level II code G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day. Append modifier KX Specific required documentation on file to related line items when the PR program exceeds the first 36 sessions.
See Medicare Benefit Policy Manual, Pub. 100-02, chapter 15, section 231 for benefit details and Medicare Claims Processing Manual, Pub. 100-04, chapter 32, section 140 for additional claims processing instructions.
Source: Centers for Medicare & Medicaid Services (CMS) Transmittal 124, Change Request (CR) 6823, issued May 7.

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