CMS will only cover PR services for patients diagnosed with moderate to very severe COPD (GOLD classification II, III and IV).
In addition to the stipulation that the patients must meet GOLD classification II, III and IV, there are five specific components to any PR program that must be met and documented to insure coverage by CMS.
Physician Prescribed Exercise – CMS guidelines require that PR conditioning include both low and high intensity exercise to produce maximum clinical benefit at a minimum of twice per week.
Education and Training – CMS encourages the physician to individualize the education and training based on the patient’s medical condition and social situation. Program goals include guidance on ADL independence, understanding and adapting to personal limitations and improving other overall quality of life.
Psychosocial assessment – Documentation should support a patient’s mental and emotional status as it relates to respiratory conditioning. CMS recommends the assessment should include an evaluation of the patient’s home situation affecting the treatment parameters along with overall response and progress gained as part of the treatment plan.
Outcome Assessment – Both beginning and ending assessments are required to assess overall outcome of the PR program. Clinical parameters should be measured including but not limited to the 6 minute walk, weight, exercise performance, self-reported shortness of breath, emotional well being and quality of life.
Individual Treatment Plan – Each plan must be documented according to the patient’s individual diagnosis. It must be established, reviewed and signed by the PR physician every 30 days. Plans may be developed by the referring provider but officially approved and signed off from the PR physicia