CMS decided Medicare will cover supervised exercise therapy to treat symptomatic peripheral artery disease.
In its May 25 decision, CMS said as many as 36 sessions over a 12-week period are covered for beneficiaries with intermittent claudication if certain parts of a SET program are met. For instance, SET sessions must last 30-60 minutes "comprising a therapeutic exercise-training program for PAD in patients with claudication," according to the agency. The SET program also must take place in a hospital outpatient setting, or a physician's office, among other requirements.
CMS said Medicare Administrative Contractors may cover SET sessions beyond the predetermined amount with a second referral, but noted Medicare will not cover SET for beneficiaries "with absolute contraindications to exercise as determined by their primary physician."
CMS approved Medicare coverage for SET for PAD after the American Heart Association in September asked the agency to do a national coverage analysis for SET for symptomatic PAD. Previously, Medicare has only covered physician-prescribed supervised exercise for cardiac rehabilitation for heart disease.
"We couldn't be more thrilled with [this] decision that will give more Americans the access they need to this important treatment option," the American Heart Association said in a statement.
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