Health Information Management

Tip: Meet CMS' new pulmonary rehabilitation guidelines

APCs Weekly Monitor, February 19, 2010

Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!

All Medicare patients with moderate, severe, or very severe classifications of chronic obstructive pulmonary disease (COPD) are now eligible to participate in pulmonary rehabilitation. For non-COPD patients, CMS has instructed local contractors to continue coverage of “respiratory care services” for non-COPD patients,  under most local coverage rules. 
 
The pulmonary rehabilitation program must include:
  • Education or training closely and clearly related to the individual’s care
  • Psychosocial assessment
  • Outcomes assessment
  • An individualized treatment plan (ITP)
 
The referring physician or the medical director can establish the ITP. However, the medical director must review and sign an initial ITP developed by a referring physician. 
 
Each session of pulmonary rehabilitation services must last at least 31 minutes. Patients can participate in a maximum of two sessions of pulmonary rehabilitation each day. In order to report two sessions on the same day the treatment must  last for a total of at least 91 minutes. 
 
Medicare will cover up to 36 sessions, but does not have a required window of time for completion of a pulmonary rehabilitation program.  
 
This tip is adapted from “Comply with CMS guidelines for cardiac, pulmonary rehab” in the February issue of Briefings on APCs.



Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor!

Most Popular

Related Articles