Medicare Guidelines for Pulmonary Rehabilitation
Medicare covers pulmonary rehabilitation programs if you have moderate to severe chronic obstructive pulmonary disease (COPD). Medicare Part B will pay for 80 percent of the cost of pulmonary rehabilitation, with a deductible that also applies. You’ll then pay 20 percent for doctor’s office visits or a copayment if you decide to go to a hospital outpatient setting.
Medicare Coverage for Pulmonary Rehabilitation
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.
- Psychosocial assessment
- Outcomes assessment
- Treatment plan
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.
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.
Expected Costs for Pulmonary Rehabilitation Under Medicare
Medicare Part B will cover 80 percent 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 percent 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.
What Is Pulmonary Rehabilitation?
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.
- Improved breathing
- Increased strength
- Decreased anxiety and depression
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.
8 Cited Research Articles
- U.S. Centers for Disease Control and Prevention. (2019, July 19). Basics About COPD. Retrieved from https://www.cdc.gov/copd/basics-about.html
- U.S. Centers for Medicare & Medicaid Services. (2012, November 23). Pulmonary Rehabilitation (PR) Services. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6823.pdf
- U.S. Centers for Medicare & Medicaid Services. (2007, September 25). Decision Memo for Pulmonary Rehabilitation. Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=199
- National Heart, Lung and Blood Institute. (n.d.). Pulmonary Rehabilitation. Retrieved from https://www.nhlbi.nih.gov/health-topics/pulmonary-rehabilitation
- U.S. Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination for Pulmonary Rehabilitation Services. Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCAId=130&NcaName=Smoking+%26+Tobacco+Use+Cessation+Counseling&ExpandComments=n&CommentPeriod=0&NCDId=320&NCSelection=NCA%7CCAL%7CNCD%7CMEDCAC%7CTA%7CMCD&KeyWord=Pulmonary+Rehabilitation&KeyWordLookUp=Doc&KeyWordSearchType=And&kq=true
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Pulmonary rehabilitation programs. Retrieved from https://www.medicare.gov/coverage/pulmonary-rehabilitation-programs
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What’s Medicare Supplement Insurance (Medigap)? Retrieved from https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
- U.S. Department of Health & Human Services. (n.d.). What is Medicare Part C? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html