Outpatient Pulmonary Rehabilitation

Outpatient pulmonary rehabilitation is covered as a single supervised ambulatory course—including exercise conditioning and multidisciplinary assessment—for medically stable patients with moderate-to-severe chronic pulmonary disease (e.g., COPD, asthma, cystic fibrosis, bronchiectasis), for preoperative conditioning and post-lung transplantation, and (in Illinois under PA 103‑0458) for children with neuromuscular/neurological/cognitive impairment. Coverage is limited to one outpatient course for patients whose symptoms and quality-of-life deficits persist despite optimal medical management; home-based programs, repeat courses, programs lacking exercise conditioning, use for PASC or after other types of lung surgery, and patients with specified contraindications (e.g., unstable cardiac disease, severe psychiatric disturbance, active substance abuse, metastatic cancer) are excluded.

"A single course of outpatient pulmonary rehabilitation for treatment of chronic pulmonary disease in individuals with moderate-to-severe disease who have disabling symptoms and significantly dimini..."