Medicare Guidelines for Pulmonary Rehabilitation

Since Medicare coverage includes medically necessary treatments, pulmonary rehabilitation is included under Part B.

Your coverage includes 36 sessions, including two one-hour sessions per day. If the treatment remains imperative to your health even after those initial sessions, then you could receive up to 72 sessions.

According to the National Heart, Lung and Blood Institute, pulmonary rehabilitation can help people with asthma, pulmonary hypertension and cystic fibrosis.

But Medicare only specifies coverage of pulmonary rehabilitation for those with moderate to severe COPD. At this point, those struggling with COPD are experiencing advanced symptoms that affect their daily lives. As of Jan. 1 2022, Medicare will also cover pulmonary rehabilitation if you’ve confirmed or suspected COVID-19 and experience persistent symptoms that include respirator dysfunction for at least four weeks.

It’s important to remember that just because your doctor recommends or orders a treatment –  even if you have non-COPD conditions – that does not mean that Medicare will consider it medically necessary and cover it.

Medicare Part B will cover 80% of pulmonary rehabilitation costs if you receive treatment in a doctor’s office. A Part B deductible also applies and, once that is met, you pay 20% of the cost for doctor’s office visits.

If you receive treatment as a hospital outpatient, then you will pay a copayment for each session.

You also can be covered through a Medicare Advantage plan, which covers everything included in Original Medicare and features additional benefits.

If you have Medicare Advantage, check with your plan provider to learn if additional coverage is available that is related to pulmonary rehabilitation.

A Medigap plan could also help with some of the out-of-pocket costs you will pay for the rehabilitation, including your Part B deductible and coinsurance.

Pulmonary rehabilitation can improve your daily life if you have COPD, a group of ailments that can impact your breathing, often caused by smoking.

According to the U.S. Centers for Disease Control, COPD can cause coughing, wheezing, shortness of breath and difficulty taking deep breaths. Pulmonary rehabilitation can help alleviate some of these symptoms.

Pulmonary rehab can include a variety of exercises. According to the National Heart, Lung and Blood Institute, these activities range from breathing techniques like pursed-lip or yoga breathing to nutritional counseling on which foods best fit your condition.