Supervised Exercise Therapy for Peripheral Artery Disease – Final Medicare Coverage Policy updated 03/15/18

Updated 3/15/18

For those of you who are ready to supervised exercise therapy for PAD patients, you can go ahead and start.  At this time, there will not be an LCD created by Palmetto GBA.  If it is warranted in the future, then they will do so but as of now, it is a go ahead.  If you are an AACVPR member you can refer to the reimbursement update section on the AACVPR website for more details on billing and coding and recommendations / requirements.   Please let your Vice President know if you have any questions!

 

CMS (The Centers for Medicare & Medicaid Services) has released the final regulation to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=287). The effective date is the publication date of the rule: May 25, 2017.  Coding and payment information has not been released at this time. It is typical with a new coverage policy that MACs (Medicare Administrative Contractors) may ask providers to hold claims submissions and will hold reimbursement until MAC software is ready to process claims for this newly covered service.

Referrals for SET must be obtained following a face-to-face visit with the physician responsible for PAD treatment.  At this visit, the beneficiary must receive information regarding cardiovascular disease and PAD risk factor reduction, which could include education, counseling, behavioral interventions, and outcome assessments.

Key requirements of a SET PAD program are:

  • Up to 36 sessions over a 12 week period are covered;
  • Sessions consisting of 30-60 minutes comprising a therapeutic exercise-training program for PAD in patients with claudication;
  • Must be conducted in a hospital outpatient setting or a physician’s office;
  • Must be delivered by qualified auxiliary personnel who are trained in exercise therapy for PAD;
  • The program is under the direct supervision of a physician, or physician assistant, nurse practitioner, or clinical nurse specialist who must be trained in both basic and advanced life support techniques.

SET PAD is a separate and distinct program from cardiac rehabilitation (CR).  It should be noted that ECG monitoring and monthly ITPs are not components of SET PAD.