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Issue Number - Name
0140-Pulmonary Rehabilitation
Review Type
Complex
Claim Type
Outpatient Hospital
Region and State
RAC 1-4
All States
Date Approved
02/05/2019

Description

Pulmonary rehabilitation is a physician-supervised program for COPD and certain other chronic respiratory diseases

Affected Codes

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
Social Security Act (SSA), Title XVIII-(s)(2)(CC)(fff), Part E-Miscellaneous Provisions-Definitions of Services, Institutions, ETC-Pulmonary Rehabilitation Program
42 CFR, Section 410.47-Pulmonary Rehabilitation Program: Conditions for Coverage
42 CFR, Section 405.980-Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)-Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
42 CFR, Section 405.986-Good Cause for Reopening  
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 3-Verifying Potential Errors and Taking Corrective Actions, Section 3.2.3.8-No Response or Insufficient Response to Additional Documentation Requests
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 231
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 32, Section 140
CMS Transmittal, R1966CP-Pulmonary Rehabilitation (PR) Services; Issue Date
 5/7/2010, Implementation Date 10/4/2010
LCA A52770-Pulmonary Rehabilitation, original effective date, 10/01/2015, Revision
Date, 10/08/2018
LCA A56152-Pulmonary Rehabilitation, original effective date, 10/08/2018