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  • CMS Issues Coding, Other Details on Supervised Exercise Therapy for Peripheral Artery Disease

    US Centers for Medicare and Medicaid Services (CMS) has released details on how it will process claims made as a result of its decision to cover supervised exercise therapy (SET) in the treatment of peripheral artery disease (PAD).

    The expansion covers physician-referred SET for up to thirty-six 30- to 60-minute sessions over a 12-week period. The sessions must be conducted in a physician's office or outpatient facility, and must be delivered by "qualified auxiliary personnel" that includes physical therapists, nurses, and exercise physiologists. Supervision is to be conducted by a physician or "non–physician practitioner"—a physician assistant, or nurse practitioner/clinical nurse specialist.

    Although CMS announced the change in May 2017, it only recently released the nuts-and-bolts around provider coding and claims processing for Medicare Administrative Contractors (MACs). Details are available from 3 resources:

    To receive coverage for SET, Medicare beneficiaries with PAD must have a face-to-face visit with a physician and be referred for the program. The physician visit must also include education on cardiovascular disease and PAD risk reduction. Medicare Administrative Contractors can allow for more sessions or a second set of 36 sessions, but these additional sessions require another referral.


    • Does this include PTAS? It includes exercise physiologist.

      Posted by Polly Bowers-Maness on 2/13/2018 9:11 PM

    • AACVPR guidelines do not exclude PTAs. We use them for our programs as long as they receive proper training, ACLS certified, etc. just like any other medical personnel running the program.

      Posted by Joell Stuckey on 2/15/2018 11:12 AM

    • FYI: The CMS made a revision of April 11, 2018, to clarify that the SET program must be provided in a physician’s office (Place of Service code 11). All other information remains the same. What's the impact on PT reimbursement outside the physician office?

      Posted by Paula Adams -> >JS^= on 4/12/2018 1:31 PM

    • @Paula: The SET program must be conducted in a hospital outpatient setting or physician’s office. The manual states that for professional claims, contractors will accept claims for CPT 93668 only when services are provided for place of service 11. For institutional claims, contractors will pay claims for SET services containing CPT 93668 on TOBs 13X under OPPS and 85X based on reasonable cost. The manual goes on to state that “Contractors shall deny claims for SET services for POS other than 11, or when services are provided on other than TOBs 13X and 85X using the following messages: MSN 15.20: “The following policies NCD 20.35 were used when we made this decision.” For more information, see: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10295.pdf

      Posted by APTA Staff on 4/16/2018 11:59 AM

    • Please clarify: Can an Outpatient Physical Therapy private practice qualify in earlier statement as "physician office or outpatient facility". We bill place of service as 11 as services are provided in PHYSICAL THERAPIST'S Office...so technically not a PHYSICIAN'S office. Am I splitting hairs or does this actually make a difference?

      Posted by Patricia J Graham on 8/30/2018 3:16 PM

    • @Patricia--Thanks for the question. Unfortunately, a PT in private practice is not considered a physician's office for purposes of this rule. For additional context, please check out the CMS Decision Memo on SET for PAD at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=287

      Posted by APTA Staff on 8/31/2018 8:07 AM

    • PT is not supervised by MD office As 99% of MD’s don’t even know what it is and neither do most PT’s. HHH.Gov. OAG consider $. For 20 year old Home PT for 20mins. Stealing from Medicare for work not done Explain what PzaD is. Home excercise Using tech. Still. Massage hat cold even acupressure. Dr Jane Cowles. “Informed Consent” 1975. “Pain Relief”. 1995 Medical needs to learn up

      Posted by Jane Smith on 5/4/2019 8:25 PM

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