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Which of the following are reasonable expectations for a pulmonary rehabilitation program

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Cardiac and Pulmonary Rehabilitation Programs

Medicare established coverage provisions for Cardiac Rehabilitation (CR) and Pulmonary Rehabilitation (PR) programs. The regulation at 42 CFR 410.49 includes coverage provisions for CR and PR items and services, physician standards and limitations to the sessions that may be covered.

Access the below related information from this page.

  • Cardiac Rehabilitation (CR) Program
  • Pulmonary Rehabilitation (PR) Program
  • CR, Intensive Cardiac Rehabilitation (ICR) and PR Orders

Cardiac Rehabilitation Program

Coverage CriteriaPatients must meet one or more of the following:
  • Have a documented diagnosis of acute myocardial infarction within preceding 12 months; or
  • Have had coronary bypass surgery; or
  • Have current stable angina pectoris; or
  • Have had heart valve repair/replacement; or
  • Have had percutaneous transluminal coronary angioplasty or coronary stenting; or
  • Have had a heart or heart-lung transplant
  • Stable, chronic heart failure defined as patients with left ventricular ejection fraction of 35% or less and NY Heart Association class II to IV symptoms despite being on optimal heart failure therapy for at least six (6) weeks
  • Other cardiac conditions as specified through an NCD. The NCD process may also be used to specify non-coverage of a cardiac condition for ICR if coverage is not supported by clinical evidence
ComponentsMust include the following:
  • Physician prescribed exercise each day cardiac rehab items and services are furnished;
  • Cardiac risk factor modification, including education, counseling and behavioral intervention at least once during program, tailored to patient's needs;
  • Psychosocial assessment;
  • Outcomes assessment; and
  • An individualized treatment plan detailing how components are utilized for each patient

Pulmonary Rehabilitation Program

Coverage CriteriaPulmonary rehab services are for patients with moderate to very severe COPD (defined as GOLD classification II, III, IV), when referred by the physician treating chronic respiratory disease; Who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks (effective January 1, 2022). Additional medical indications for coverage may be established through an NCD.
  • Must include the following:
    • Physician-prescribed exercise. Some aerobic exercise must be included in each session;
    • Education or training closely and clearly related to individuals care and treatment which is tailored to their needs
    • Psychosocial assessment;
    • Outcomes assessment; and
    • An individual treatment plan detailing how components are utilized for each patient
Sessions
  • Rehabilitation services should not exceed 36 sessions
  • Limited to a maximum of 2 1-hour sessions per day
  • If Completing 2 one-hour sessions per (equates up to 18 weeks)
  • Two sessions only reported same day if treatment duration is at least 91 minutes
  • Each unit reported must be at least 31 minutes in length
Duration
  • Acceptable termination
  • Achieved a stable level of exercise tolerance
  • Symptoms of angina are stable at maximum exercise level
  • Resting blood pressure and heart rate are normal
  • Stress test is not positive during exercise
Stress TestingReasonable for one or more of the following:
  • Evaluation of chest pain
  • Development of exercise prescriptions
  • Pre and Postoperative evaluation of patients undergoing coronary artery by-pass procedures
Frequency Edits
  • Claims exceed two units on same date of service
  • KX modifier is not present over 36 sessions for CPT 94625 and 94626
  • Patient may require additional 36 sessions for COVID-19 if he/she previously received PR services for COPD initially or vice versa
  • Additional sessions for second approved condition, must append KX modifier to subsequent 36 sessions.

CR, ICR, and PR Orders

To comply with federal statute, Medicare covered CR, ICR and/or PR services must be ordered by a Medical Doctor or Doctor of Osteopathy licensed in the state where the services are rendered. For either CR, ICR or PR, the medical director or supervising MD/DO must be present and immediately available during rehab activities.

The sole exception, per § 512.630, is for a provider or supplier of CR and ICR services to an Episode Payment Model beneficiary during an AMI and CABG episode, as defined in § 512.2, wherein CMS waives the physician definition to allow the functions of supervising physician, prescribing exercise, and establishing, reviewing, and signing an individualized treatment plan for CR and ICR services to be furnished under the direction of:

  1. A physician, as defined in section 1861(r)(1) of the Act; or
  2. A qualified nonphysician practitioner, as defined by CMS.

Questions regarding Advancing Care Coordination through Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model can be directed to .

Resources

  • CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.9, 20.6.10, and 61.3-61.3.6
  • CMS Change Request (CR) 6850 - Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
  • CR 6823 - Pulmonary Rehabilitation (PR) Services
  • CR 12613 - Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage
  • Cardiac Rehabilitation Programs (20.10) National Coverage Determination (NCD)
  • Billing and Coding: Pulmonary Rehabilitation Services (A52770)

Last Updated Mon, 05 Dec 2022 20:54:24 +0000

What can I expect from pulmonary rehab?

What happens during pulmonary rehabilitation? To help design your pulmonary rehabilitation plan, your healthcare team may do one of the following tests: Exercise stress test to measure your oxygen level, blood pressure, and heart rate while you exercise. Breathing tests to check how well your lungs are working.

Which of the following are components of a pulmonary rehabilitation program?

Components of Pulmonary Rehabilitation.
Exercise training..
Inspiratory muscle training..
Neuromuscular electrical stimulation..
Psychosocial counseling..
Nutritional evaluation and counseling..
Education, including on proper use of prescribed drugs..

What are the three components of a cardiopulmonary rehabilitation program quizlet?

What is a cardiac rehabilitation program? a multidiscipline program of exercise, education, and lifestyle modification and is a covered service under the Centers for Medicare and Medicaid and outlined in a National coverage Determination, including a description of the patient diagnosis, program components, etc.

What is the significant role of pulmonary rehabilitation?

Pulmonary rehabilitation aims to reduce symptoms, decrease disability, increase participation in physical and social activities, and improve the overall quality of life (QOL) for patients with chronic respiratory disease.

reasonable expectations pulmonary rehabilitation program Pulmonary rehabilitation Quizlet

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