CMS Pub. 100-03, ch. 1, § 240.8

A. General

Pulmonary rehabilitation was defined in a 1999 joint statement of the American Thoracic Society and the

European Respiratory Society 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.

Although services that make up pulmonary rehabilitation individually may be covered under Medicare and

fall into various applicable benefit categories, the Centers for Medicare & Medicaid Services (CMS) has

determined that the Social Security Act (the Act) does not expressly define a comprehensive Pulmonary

Rehabilitation Program as a Part B benefit. In addition, respiratory therapy services are identified as covered

services under the Comprehensive Outpatient Rehabilitation Facility benefit and defined in 42 CFR

410.100(e)(1) to (2)(vi).

B. Nationally Covered Indications

N/A

C. Nationally Non-Covered Indications

N/A

D. Other

The CMS has determined that a national coverage determination (NCD) for pulmonary rehabilitation is not

appropriate at this time. A/B MACs (A) and (B) should continue to make decisions under §1862(a)(1)(A) of

the Act through their local coverage determination (LCD) process or by case-by-case adjudication. See

Heckler v. Ringer, 466 U.S. 602, 617 (1984) (Recognizing that the Secretary has discretion to either

establish a generally applicable rule or to allow individual adjudication.). See also, 68 Fed. Reg. 63692,

63693 (November 7, 2003). LCDs can be accessed from the CMS search engine located at:

http://www.cms.hhs.gov/mcd/search.asp.