icd code for supervised exercise therapy for pad

Is supervised exercise therapy for symptomatic peripheral artery disease (PAD) covered by CMS?

NOTE: CMS determined that the National Coverage Determination requiring coverage of supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) would be considered a significant cost under section 422.109(a)(2) of title 42 of the Code of Federal Regulations.

What is the CPT code for pad rehabilitation?

Providers should use Current Procedural Terminology (CPT) 93668 (Under PAD Rehabilitation) to bill for these services with appropriate ICD-10 Code as follows:

Is supervised exercise therapy (set) covered by Medicare or Medicaid?

See Appendix B for the NCD manual language. The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD).

How many patients with IC completed a supervised 12-week exercise program?

VASA 2008;37 (3):250-256. DOI; 10.1024/0301-1526.373.250 Sixty-seven patients with IC who completed a supervised 12-week exercise program at least 6 months before study enrollment were asked to participate in follow-up evaluation.

What is supervised exercise therapy?

Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD.

What is ICD 10 code for peripheral artery disease?

Peripheral Artery Disease (ICD-10 code I73. 9) is estimated to affect 12 to 20% of Americans age 65 and older with as many as 75% of that group being asymptomatic (Rogers et al, 2011).

What is the ICD 10 code for claudication?

Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity. I70. 219 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM I70.

How do you code peripheral vascular disease?

ICD-10-CM Code for Peripheral vascular disease, unspecified I73. 9.

What is the CPT code for PAD?

The CPT code is 93668, under Peripheral Arterial Disease Rehabilitation.

What is the ICD 10 code for left claudication?

"I70. 212 - Atherosclerosis of Native Arteries of Extremities With Intermittent Claudication, Left Leg." ICD-10-CM, 10th ed., Centers for Medicare and Medicaid Services and the National Center for Health Statistics, 2018.

Is PAD a CVD?

PAD is a form of cardiovascular disease (CVD) because it affects the blood vessels. It's usually caused by a build-up of fatty deposits in the walls of the leg arteries. The fatty deposits (atheroma) are made up of cholesterol and other waste substances.

What is the ICD 10 code for right common femoral artery stenosis?

213.

What is the ICD 10 code for leg pain?

606.

General Information

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process that claim.

Article Guidance

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication.

ICD-10-CM Codes that DO NOT Support Medical Necessity

All other ICD-10-CM codes not listed under “ICD-10-CM Codes that Support Medical Necessity” will be denied as not medically necessary.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

What is set exercise?

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.

How many sessions does Medicare cover for SET?

On May 25, 2017, CMS issued an NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Medicare will cover up to 36 sessions over a 12-week period if all of the following components of a SET program are met:

Does Medicare allow professional claim services for POS 11?

Medicare allows professional claim services for SET only in place of service (POS) 11 (office). MACs will deny claims with any other POS for SET on or after May 25, 2017, using the following messages

What is Medicare Advantage Policy Guideline?

The Medicare Advantage Policy Guideline documents are generally used to support UnitedHealthcare Medicare Advantage claims processing activities and facilitate providers’ submission of accurate claims for the specified services. The document can be used as a guide to help determine applicable:

Is SET a revascularization treatment?

SET has also been shown to perform at least as well as more invasive revascularization treatments that are covered by Medicare.

Does Medicare cover exercise therapy?

The Centers for Medicare & Medicaid Services (CMS) has determined that there is sufficient evidence to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (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:

Description Information

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Transmittal Information

02/2018 - The purpose of this Change Request (CR) is to inform contractors that effective May 25, 2017, the Centers for Medicare and Medicaid Services (CMS) issued an NCD to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. ( TN 204 ) (CR10295)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Decision Summary

The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD).

Decision Memo

The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD).