Billing and Coding: Pulmonary Rehabilitation Services

Medicare covers pulmonary rehabilitation either as individual components when medically necessary and provided by qualified clinicians, or as a Pulmonary Rehabilitation Program when all CMS manual and NCD 240.8 program requirements are met. Program coverage includes patients with moderate to very severe COPD (GOLD II–IV) and, since Jan 1, 2022, confirmed or suspected COVID-19 with persistent respiratory symptoms ≥4 weeks, with payment limits of up to two one-hour sessions per day and up to 36 sessions (plus a possible second 36-session block for a second approved condition billed with modifier KX).

"Individual pulmonary rehabilitation components are covered when tailored to the individual patient based on a thorough evaluation, require a qualified clinician due to complexity, and are medically..."

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