Pulmonary Rehabilitation

Comprehensive pulmonary rehabilitation and respiratory therapy services benefit patients with chronic lung disease and other diseases of the lung by reducing symptoms and restoring independent function. Although the science of these therapies is not new, commercial payers and Medicare have generally been slow to support adequate coverage and reimbursement. These therapies are described as a multidisciplinary approach to individual patient care through a physician-supervised program that usually includes physician-prescribed exercise, education and/or training, psychosocial assessment, and an outcomes assessment comprehensively documented using an individualized treatment plan. This article includes a review of the requirements based on the July 2008 Congressional enactment of a new national policy for comprehensive pulmonary rehabilitation program coverage. Passage of Section 144 of the Medicare Improvements for Patients and Providers Act authorizes comprehensive pulmonary rehabilitation programs to be a covered Medicare benefit. Variability of coverage by various payers will be examined. Also discussed are various coding schema for the provision and reporting of comprehensive pulmonary rehabilitation and respiratory therapy services. The variability of requirements to establish medical necessity among several major payers of respiratory therapy services and comprehensive pulmonary rehabilitation programs will be explored. Despite these therapies being recognized universally as the standard of care for certain diseases and a new national mandate establishing coverage regulations, the continuation, expansion, and patient access for such therapies may be limited. Pitfalls and pluses are discussed.