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CMS Proposes Positive Pulmonary Rehab Payment Changes

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June 28, 2010

The Centers for Medicare and Medicaid Services (CMS) announced today its proposed payment policies under the physician fee schedule and other revisions to Part B for CY 2011. Of particular interest are proposed changes to the payment rates for pulmonary rehabilitation (PR) services. This is is very positive news as there were many concerns that the payment rate was too low.

CMS proposes to increase the work relative value units for HCPCS code G-0424 to be comparable to those for cardiac rehabilitation with monitoring, in view of the monitoring required in PR. Additional changes include increasing the clinical labor time for the respiratory therapist from 15 minutes to 30 minutes and crosswalking the practice expense (PE) equipment inputs for G-0424 to the respiratory treatment services (G-0238) which include a 1-channel ECG and a pulse oximeter. Although the treadmill currently assigned to G-0424 will be retained, CMS will adjust the equipment time to 45 minutes.

Some of these changes are in response to follow-up comments the pulmonary multi-societies made subsequent to the final rulemaking last year. The proposed rules will be published on pages 224–226 of the July 13, 2010 Federal Register.

In light of these new proposed rule changes, the AARC and our sister pulmonary organizations will be discussing whether to submit joint comments to CMS (as we have done in the past) or individual comments.