Billing and Coding: Pulmonary Rehabilitation Services

Medicare covers pulmonary rehabilitation either as individual component services (billed with HCPCS G0237–G0239 or therapy CPT 97xxx depending on provider) or as a Pulmonary Rehabilitation Program when program-specific requirements are met; individual components are payable only with documentation of medical necessity, a thorough individualized evaluation, and complexity requiring a qualified clinician, and must be provided under the appropriate physician or therapy plan of care. Excluded/not separately billable items include pulse oximetry, counseling, education, and the 6‑minute walk test; incident-to services cannot be provided by PTAs/OTAs, and therapy modifiers and revenue codes (GP/GO and 42x/43x) should not be used.