Q&A: Reimbursement for peripheral artery disease rehabilitation
Q: Our vascular physician prescribes exercise to some of his patients who have peripheral artery disease (PAD). He wants to provide the exercise program in the office, because he wants to have these patients monitored closely for their response, due to the nature of the disease. Is there a way to get reimbursed for this since it is a therapeutic procedure for these patients?
A: CMS has issued a new coverage guideline for PAD rehabilitation. The decision begins coverage of supervised exercise therapy for beneficiaries who have intermittent claudication as a result of symptomatic PAD. The effective date is May 25, 2017. Some of the specific coverage requirements include, but are not limited to:
- The session must last 30–60 minutes and be provided in a physician office or hospital outpatient department
- The session must provide a therapeutic exercise-training program for PAD patients with claudication
- The therapy must be delivery by qualified auxiliary personnel who are trained in exercise therapy for PAD to ensure the benefits outweigh any harm
- The therapy must be under the direct supervision of a physician, physician assistant, nurse practitioner, or clinical nurse specialist. The provider responsible for the supervision must be trained in both basic and advanced life support techniques.
The exercise therapy will be reported with CPT code 93668 (PAD rehabilitation, per session), which is assigned to status indicator S (significant procedure, not discounted when multiple) and assigned to APC 5733 (Level 3 Minor Procedures). This information is included in the October 1 Addendum B.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.
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