ALERT!! 2022 CMS CHANGES FOR PULMONARY REHAB:
For CY 2022, the AMA's CPT Editorial Panel created two new codes describing pulmonary rehabilitation services and requested that CMS delete HCPCS code G0424 (Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day). We proposed to assign CPT code 94625 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)) and CPT code 94626 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session)) to APC 5733 (Level 3 Minor Procedures) with a proposed payment rate of S57.12. We note that CPT codes 94625 and 94626 were listed as placeholder codes 946X 1 and 946X2, respectively, in OPPS Addendum B of the CY 2022 OPPS/ASC proposed rule.
Comment: Several commenters disagreed with the proposed APE' assignment and requested that CMS reassign CPT codes 94625 and 94626 to either APC 5721 (Level 1 Diagnostic Tests and Related Services) with a proposed payment rate of $143.21 or to APC 5771 (Cardiac Rehabilitation) with a proposed payment rate of $119.09. These commenters stated that these APCs better reflected the clinical similarity and Costs associated with furnishing these services.
Response: CPT codes 94625 and 94626 do not describe diagnostic tests and so are not clinically similar to the other services in APC 5721. While clinically similar to cardiac rehabilitation services, predecessor HCPCS code G0424 has a geometric mean cost of $45.63 based on 198,132 single claims (out of 199,356 total claims), which is significantly lower than the geometric mean cost of $113.12 for the services in APC 5771. Based on our analysis, we believe that assignment of CPT codes 94625 and 94626 to APC 5733 is appropriate because their costs are consistent with the cost data of the predecessor code. We note that we review, on an annual basis, the APC assignments for all items and services paid under the OPPS. We will consider whether the current APC structure adequately reflects the clinical similarities and costs associated with pulmonary rehabilitation services in future rulemaking.
In summary, after consideration of the public comments, we are finalizing our proposal without modification to assign CPT codes 94625 and 94626 to APC 5733. The final CY 2022 OPPS payment rates for the codes can be found in Addendum B to this final rule with comment period. In addition, we refer readers to Addendum D1 of this final rule with comment period for the SI meanings for all codes reported under the OPPS. Both Addendum B and D1 are available via the intend on the CMS website.
** AACVPR will host a live webinar, 2022 Medicare Regulations and Legislative Priorities, on December 7 from 12:00-1:00pm CT to update and identify any changes to the 2022 Medicare regulations for CR/ICR/PR programs. Save your seat now- register on AACVPR.org!
Updates on Health Policy and Reimbursement
Public Health Emergency Update
AACVPR recently learned that HHS has announced the Public Health Emergency (PHE) will likely remain in place for the entirety of 2021. What does this mean for CR/PR/ICR programs? View AACVPR's comprehensive Fact Sheet.
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February 3, 2021
AACVPR: Health Policy & Reimbursement Update AACVPR recently learned that HHS has announced the Public Health Emergency (PHE) will likely remain in place for the entirety of 2021 October 20, 2020
AACVPR: Health Policy & Reimbursement Update CMS adds cardiac, intensive cardiac, and pulmonary rehabilitation to telehealth codes for physician office-based programs during the Public Health Emergency |
September 23, 2020
AACVPR: Health Policy & Reimbursement Update Delivery of Cardiac and Pulmonary Rehabilitation – Opportunities During the COVID-19 Pandemic October 9, 2020
AACVPR: Health Policy & Reimbursement Update Extension of COVID-19 Pandemic extends Opportunities for Delivery of Cardiac and Pulmonary Rehabilitation |
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TAKE OUR SHORT SURVEY
CSPR and your colleagues are thinking about you during this challenging time. We are hoping to understand the impact of the pandemic and shelter in place as a starting point of developing strategies for CA Pulmonary Rehabilitation providers and patients. Please help us by answering questions in our short survey. Thank you in advance for your help.
Vital Signs, Oxygen, & Exercise Prescription. How are these impacted by COVID-19 By Ellen Hillegass
CMS WAIVES IN-PERSON TESTING FOR MEDICARE OXYGEN PATIENTS
COVID-19 and Telehealth update from AACVPR
CMS Rejects Telehealth Reimbursement for CR/PR
The COVID-19 pandemic has had a huge impact on cardiac and pulmonary rehabilitation professionals and our patients.…Read AACVPR Update
The COVID-19 pandemic has had a huge impact on cardiac and pulmonary rehabilitation professionals and our patients.…Read AACVPR Update
European Respiratory Society
Please see the link below for an important resource from the European Respiratory Society Ad-hoc International Task Force who have published an expert-based opinion on early- and short-term rehabilitation interventions in COVID-19 survivors. It will be updated at least every two weeks. The group welcomes input from the rehabilitation community via this link:
Coronavirus Disease 2019 (COVID-19)
Healthcare Professional Resources
Coronavirus Disease 2019 (COVID-19)
Patient Resources
American Thoracic Society
What to do When Pulmonary Rehabilitation (PR) is Unavailable
PATIENT EDUCATION | INFORMATION SERIES
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American Thoracic Society
What is the Novel 2019-nCoV Coronavirus?
PATIENT HEALTH | INFORMATION SERIES
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American Thoracic Society
Novel Wuhan (2019-nCOV) Coronavirus
PUBLIC HEALTH | INFORMATION SERIES
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CSPR is a Joint Affiliate of AACVPR
Joint Affiliate (JA) CSPR/AACVPR Membership
Join today and get two memberships – CSPR & AACVPR.
Become a joint affiliate member now. Your membership cycle will be July 1, 2019 to June 30, 2020.
Need help accessing CSPR Members Only pages?
OUR OBJECTIVES
 Education
To support the efforts of other organizations having similar interests to those of CSPR. |
 Awareness
To support the efforts of other organizations having similar interests to those of CSPR. |
 Communication
To support the efforts of other organizations having similar interests to those of CSPR. |
 Development
To develop recommendations for guidelines of care for pulmonary rehabilitation programs. |
 Advocacy
To support the efforts of other organizations having similar interests to those of CSPR. |
UPCOMING MEETINGS & EVENTS
At this time, the nation has cancelled in person meetings and events, however, there's a rich source of webinars/webcasts that come with your CSPR/JA membership.
Check out AACVPR's Events & Education and Resources.
CSPR is joining the Call to Action with the American Thoracic Society (ATS) to improve Pulmonary Rehabilitation awareness
Additional information is available at LIVEBETTER.ORG
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Bulletin for ATS PR Assembly
Please review and share with colleagues!
Pulmonary rehabilitation is known to improve quality of life for patients with COPD and other lung diseases. The problem? Not enough patients, or their doctors, know about this treatment option.
To help address that knowledge gap, the ATS has partnered with the Gawlicki Family Foundation to launch a pilot program to increase public awareness of pulmonary rehab. At the center of the campaign is a new, patient-friendly website: www.livebetter.org.
On the website, visitors will find a number of resources to help patients (and their family, friends, caregivers and doctors) answer an important question: Is pulmonary rehab right for me? Related resources, include:
Resources explaining pulmonary rehab and its benefits
Directory of pulmonary rehab programs across the United States
Criteria for selecting a PR Program and the enrollment process
Patient stories
Frequently Asked Questions
The campaign is also being promoted through a public relations campaign. Here are a few recent news articles which were subsequently published in numerous other news outlets:
Physician's Briefing: "Patients Hospitalized for COPD Rarely Receive Pulmonary Rehab," November 16, 2016
Everyday Health: "Most COPD Patients Are Missing Out on Pulmonary Rehab Benefits," December 6, 2018
Please share these resources, most especially www.livebetter.org, a related fact sheet and the attached social media posts, with your colleagues, patients and their families. ATS also has a Patient Education Information Series fact sheet on this topic.
Pulmonary rehab can deliver real benefits and we want as many people as possible to know.
To help address that knowledge gap, the ATS has partnered with the Gawlicki Family Foundation to launch a pilot program to increase public awareness of pulmonary rehab. At the center of the campaign is a new, patient-friendly website: www.livebetter.org.
On the website, visitors will find a number of resources to help patients (and their family, friends, caregivers and doctors) answer an important question: Is pulmonary rehab right for me? Related resources, include:
Resources explaining pulmonary rehab and its benefits
Directory of pulmonary rehab programs across the United States
Criteria for selecting a PR Program and the enrollment process
Patient stories
Frequently Asked Questions
The campaign is also being promoted through a public relations campaign. Here are a few recent news articles which were subsequently published in numerous other news outlets:
Physician's Briefing: "Patients Hospitalized for COPD Rarely Receive Pulmonary Rehab," November 16, 2016
Everyday Health: "Most COPD Patients Are Missing Out on Pulmonary Rehab Benefits," December 6, 2018
Please share these resources, most especially www.livebetter.org, a related fact sheet and the attached social media posts, with your colleagues, patients and their families. ATS also has a Patient Education Information Series fact sheet on this topic.
Pulmonary rehab can deliver real benefits and we want as many people as possible to know.
REIMBURSEMENT UPDATES
Pulmonary Rehabilitation Reimbursement Challenges and Strategies for Survival by Chris Garvey, et al.
Despite growing evidence for the clinical effectiveness of Pulmonary Rehabilitation (PR), inadequate reimbursement and limited availability continue to hinder the effective PR delivery in the US.(1) A recent analysis indicates that, in 2012, only 3.7% of Medicare-eligible COPD patients received PR (2). Low reimbursement undeniably influences the availability of what is now the standard of care in chronic lung disease.
California Society for
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