Outpatient Pulmonary Rehab Rates Set to Rise

 Updated: July 11, 2016

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Thanks in part to the Pulmonary Rehabilitation Toolkit developed by the AARC and her sister organizations, CMS has just proposed significant rate increases for outpatient pulmonary rehabilitation programs in 2017.

The toolkit helped many programs more accurately calculate charges for PR code G0424, providing a clearer picture of PR costs to CMS. An annual review conducted by CMS to determine if all services and items within the PR Ambulatory Payment Classification (APC) group were comparable from a clinical and resource use standpoint likely played a role in the rate increases as well.

The proposed rates, which include the bundled rate G0424 plus additional codes reported for patients who receive respiratory therapy services but do not qualify for the full range of components that comprise Medicare coverage of pulmonary rehabilitation under the COPD guidelines, are –

CMS Pulmonary Rehab Rate
Figure 1

While these rate increases are still subject to change as additional data become available, the AARC believes the higher rates proposed for calendar year 2017 bode well for the future of pulmonary rehabilitation programs and the patients who benefit from them.

“The proposed rate increases we see today reflect the efforts of the AARC and other organizations to work with CMS to bring a fairer reimbursement to PR programs nationwide,” says Continuing Care/ Rehabilitation Section Chair Trina M. Limberg. “As a respiratory therapist and AARC member, I am proud to know my professional organization went to bat for our programs and our patients.”