Calling the supporting evidence “at least equivalent to already covered therapies” for intermittent claudication (IC), the US Centers for Medicare and Medicaid Services (CMS) announced that it will extend Medicare coverage for supervised exercise therapy (SET) to treat peripheral artery disease (PAD).
The expansion, announced in a May 25 coverage decision, will cover physician-referred SET for up to 36 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 (PTs), nurses, and exercise physiologists. Supervision will be conducted by a physician or “non-physician practitioner”—a physician assistant, or nurse practitioner/clinical nurse specialist.
“Trials showed that SET decreases mortality, reduces cardiovascular risk factors, increases exercise capacity, and increases quality of life in older adults,” CMS states. “While in general exercise capacity alone, which was an endpoint in a number of studies, would not be an appropriate outcome, it is a meaningful outcome for IC due to symptomatic PAD since there is a well-established evidence link to all-cause mortality.”
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.