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Supervised Exercise Therapy Under Medicare Part B

by • March 12, 2018 • 16 Comments

Effective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a National Coverage Determination (NCD) to cover Supervised Exercise Therapy (SET) for beneficiaries with Intermittent Claudication (IC) for the treatment of symptomatic Peripheral Artery Disease (PAD). SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD.

CMS issued the NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions over a 12-week period are covered if all of the following components of a SET program are met:

The SET program must:

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16 thoughts on “Supervised Exercise Therapy Under Medicare Part B”

  1. Carmen Albu says:

    Can this be done in an outpatient occupational or physical therapy office with someone who has a degree in exercise science and is under the supervision of an OT or PT?

    1. Rick Gawenda says:

      No.

  2. Jody Tomasic says:

    Should an evaluation CPT code be charged on the first visit? Is 93668 a timed or untimed code?

    1. Rick Gawenda says:

      It’s a per session CPT code. Please read the documents in the article for the correct billing for SET.

  3. Jim Milani says:

    Must be provided by a PTA or COTA?

    1. Rick Gawenda says:

      Not sure what you are asking.

  4. Debra Napolitan says:

    Who would be considered qualified auxillary personnel to deliver this treatment, and what type of training would they need?

    1. Rick Gawenda says:

      They need to be trained in exercise therapy for PAD.

  5. Sandra Rastoder says:

    Can this be done in a Medicare certified ORF? If a doctor, PA etc refers the patient can an exercise physiologist employed by the ORF perform the services, can the ORF bill?

    1. Rick Gawenda says:

      No! Please re-read the article at https://gawendaseminars.com/2018/current-news-posts/supervised-exercise-therapy/ and pay special attention where it states “The SET program must:” This is where you will see what settings SET can be provided in and who can provide the service and the supervision requirements.

  6. Tom Bednar says:

    is this allowed in an outpatient PT private practice, supervised by licensed personal.

    1. Rick Gawenda says:

      Please re-read the article at https://gawendaseminars.com/2018/current-news-posts/supervised-exercise-therapy/ and pay special attention where it states “The SET program must:” This is where you will see what settings SET can be provided in and who can provide the service and the supervision requirements.

  7. Josh Amos says:

    Can this be done in an outpatient physical therapy office by a PT or PTA?

    1. Rick Gawenda says:

      Please re-read the article at https://gawendaseminars.com/2018/current-news-posts/supervised-exercise-therapy/ and pay special attention where it states “The SET program must:” This is where you will see what settings SET can be provided in and who can provide the service and the supervision requirements.

  8. Allison Orofino says:

    I doubt PT’s will be offering this service to their patients. I believe that Direct supervision requirement means that one of those type of people with advanced life support training is present at all times.

    1. Rick Gawenda says:

      I think it depends on the practice setting. If a physician owned practice or in a hospital-based practice, you could see PTs possibly be involved.

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