Pulmonary Rehabilitation

Aetna covers medically supervised outpatient pulmonary rehabilitation only for members with chronic pulmonary disease (or certain other conditions affecting pulmonary function) who have dyspnea at rest or with exertion and a demonstrable reduction in exercise tolerance that limits activities of daily living or work. Aetna excludes routine/non‑skilled or maintenance care, generally does not authorize repeat programs (except around lung transplantation or lung volume reduction surgery), considers rehabilitation for very‑severe/housebound patients not medically necessary, treats other indications as investigational, and coverage may be subject to short‑term rehab limits in the benefit plan.

"A treatment plan to attain goals with justification for continuing the rehabilitation program, including frequency and duration."

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