National Coverage Analysis (NCA) Tracking Sheet

Pulmonary Rehabilitation

CAG-00356N

Issue

Pulmonary Rehabilitation has been defined in a 1999 joint statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) as a multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy and an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systematic manifestations of the disease.

Currently, CMS does not cover pulmonary rehabilitation as a single entity. However, there is a limited benefit for some pulmonary rehabilitation services provided in a comprehensive outpatient rehabilitation facility (CORF). Certain components of pulmonary rehabilitation may fall under other existing benefit categories.

On November 15, 2006, American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), National Association for Medical Direction of Respiratory Care (NAMDRC). jointly requested that CMS promulgate an NCD which identifies the components of pulmonary rehabilitation services. The requestors suggest that this NCD should address the provision of these services in the hospital outpatient setting, the physician office setting and the CORF setting.

National Coverage Determinations

Benefit Category

No Benefit Category

Requestor Information

Requestor Name Requestor Letter
American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Chest Physicians, American Thoracic Society, National Association for Medical Direction of Respiratory Care. View Letter
N/A

Important Dates

Formal Request Accepted and Review Initiated
12/27/2006
Expected NCA Completion Date
09/25/2007
Public Comment Period
12/27/2006 - 01/26/2007
Proposed Decision Memo Due Date
Proposed Decision Memo Released
06/27/2007
Proposed Decision Memo Public Comment Period
06/27/2007 - 07/27/2007
Decision Memo Released
09/25/2007
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
Roya Lotfi
Susan Harrison
Lead Medical Officers
Ross Brechner, MD, MS, MPH

Medicare Benefit Category Determination Date

Actions Taken

December 27, 2006

CMS opens this national coverage determination request to review the coverage of pulmonary rehabilitation. CMS is requesting public comment and evidence related to pulmonary rehabilitation including; what is an appropriate definition of pulmonary rehabilitation; what are the components of pulmonary rehabilitation; is pulmonary rehabilitation conducted similarly in all settings; and what are patient outcomes for pulmonary rehabilitation? Additionally, is there adequate evidence, including clinical trials, for evaluating health outcomes of pulmonary rehabilitation in the Medicare population?

June 27, 2007

September 25, 2007