News & Commentary

Medicare Covering Exercise Sessions


Medicare has begun covering 36 sessions of supervised exercise for patients with symptomatic peri­pheral artery disease (PAD), CMS announced last month. The agency, citing guidelines by the American College of Cardiology Foundation and the American Heart Association, said that supervised exercise therapy (SET) alleviates common symptoms of cardiovascular disease, especially leg pain, and is more effective than unsupervised exercise and is at least comparable to more invasive revascularization treatments.

PAD, which occurs when plaque buildup narrows the arteries in the legs, affects 12% to 20% of Americans aged 60 or over. The incidence of PAD increases significantly with age.

Medicare set some ground rules for the SET programs it will cover. The exercise therapy must be given over a 12-week period. Programs must consist of 30- to 60-minute sessions that include a therapeutic exercise training program for PAD in patients with leg pain, be conducted by people trained to conduct PAD exercise therapy, and take place in an outpatient setting.

In addition, beneficiaries must have a physician referral to begin the treatment, and the physician should educate the patient about cardiovascular disease and how to reduce the risks.

Medicare Administrative Contractors can decide to extend the SET program for an additional 36 sessions. A second physician referral is required for the additional sessions.

UP NEXT

A blueprint for high-volume, high-quality lung cancer screening that is detecting cancer earlier—and helping to save lives

Clinical Brief

Multiple Sclerosis: New Perspectives on the Patient Journey–2019 Update
Summary of an Actuarial Analysis and Report