Part B Insider (Multispecialty) Coding Alert

Published on Thu Jul 19, 2012 PDF

CMS has allowed payment for physician-supervised pulmonary rehab programs since 2010, but the agency is still tweaking the policies to confirm that only patients with moderate to very severe COPD are entitled to the benefit.

Background: Effective Jan. 1, 2010, physician-supervised comprehensive pulmonary rehab programs have been payable for up to two hourly sessions per day, up to 36 lifetime sessions. The programs must include physician-prescribed exercise, education or training, psychosocial assessment, outcomes assessment, and an individualized treatment plan.

Update: On July 16, CMS revised MLN Matters article MM6823 to clarify that the benefit is only payable for patients with moderate to very severe chronic obstructive pulmonary disease (COPD).

To read a complete copy of the article, visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6823.pdf.