US Centers for Medicare and Medicaid Services (CMS) has released details on how it will process claims made as a result of its decision to cover supervised exercise therapy (SET) in the treatment of peripheral artery disease (PAD).
The expansion covers physician-referred SET for up to thirty-six 30- to 60-minute sessions over a 12-week period. The sessions must be conducted in a physician’s office or outpatient facility, and must be delivered by “qualified auxiliary personnel” that includes physical therapists, nurses, and exercise physiologists. Supervision is to be conducted by a physician or “non–physician practitioner”—a physician assistant, or nurse practitioner/clinical nurse specialist.
Although CMS announced the change in May 2017, it only recently released the nuts-and-bolts around provider coding and claims processing for Medicare Administrative Contractors (MACs). Details are available from 3 resources:
- A Medicare Learning Network “Medicare Matters” posting on the changes
- A CMS update to the Medicare Claims Processing Manual
- A CMS update to the Medicare National Coverage Determinations publication
To receive coverage for SET, Medicare beneficiaries with PAD must have a face-to-face visit with a physician and be referred for the program. The physician visit must also include education on cardiovascular disease and PAD risk reduction. Medicare Administrative Contractors can allow for more sessions or a second set of 36 sessions, but these additional sessions require another referral.