Health Information Management

Tip: Meet CMS' new pulmonary rehabilitation guidelines

APCs Insider, February 19, 2010

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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.



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