Supervised Exercise Therapy Approved for Medicare Patients with PAD, Medicare Guidelines For Physical Therapy
CMS has recently concluded that supervised exercise therapy improves health outcomes for Medicare patients with intermittent claudication due to peripheral artery disease (PAD) and the this exercise therapy is at least as effective (and less costly) than other treatments for PAD.
To encourage all providers to adopt and adhere to evidence-based care for patients with PAD, CMS recently announced that Medicare will cover therapeutic exercise (97110) for patients with PAD. Medicare will pay for up to 36 sessions over a 12-week period if the following conditions are met:
- The sessions much consist of 30-60 minutes of therex for PAD in patients with claudication;
- The exercise program must take place in a physician’s office (or hospital outpatient setting)
- The treatment must be delivered by a PT or PTA
- A supervising physician (but not necessarily the referring physician) must by on site; however, the supervising physician does not need to be in the therapy clinic
- Claims must be submitted under the supervising physician using the incident to rules (claims cannot be submitted under the physical therapist’s NPI)
- Note that a PA or NP can supervise this treatment and claims can be submitted under a PA/NP, however, the 15% reduction for PA/NP services would apply
More information regarding CMS’s coverage announcement and practice guidelines favoring therex issued by the American College of Cardiology, Society for Vascular Surgery and other professional associations can be found at Decision Memo for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (CAG-00449N).
Medicare Guidelines For Physical Therapy