CMS Pub. 100-04, ch. 32, § 140.4

As specified in 42 CFR 410.47, Medicare Part B covers PR for beneficiaries:

• With moderate to very severe COPD (defined as GOLD classification II, III and IV), when referred by

the physician treating the chronic respiratory disease;

• Who have had confirmed or suspected COVID-19 and experience persistent symptoms that include

respiratory dysfunction for at least four weeks (effective January 1, 2022);

• Additional medical indications for coverage for PR may be established through an NCD.

PR must include all of the following components:

• Physician prescribed exercise during each pulmonary rehabilitation session.

• Education or training that is closely and clearly related to the individual’s care and treatment which is tailored

to the individual’s needs and assists in achievement of goals toward independence in activities of daily living,

adaptation to limitations and improved quality of life. Education must include information on respiratory

problem management and, if appropriate, brief smoking cessation counseling.

• Psychosocial assessment.

• Outcomes assessment.

• An individualized treatment plan detailing how components are utilized for each patient. The individualized

treatment plan must be established, reviewed, and signed by a physician every 30 days.

Medicare Part B pays for PR in a physician’s office or a hospital outpatient setting. All settings must have the

following: (i) A physician or nonphysician practitioner immediately available and accessible for medical

consultations and emergencies at all times when items and services are being furnished under the program. This

provision is satisfied if the physician or nonphysician practitioner meets the requirements for direct supervision

for physician office services, at 42 CFR 410.26, and for hospital outpatient services at 42 CFR 410.27, and, (ii)

The necessary cardio-pulmonary, emergency, diagnostic, and therapeutic life-saving equipment accepted by the

medical community as medically necessary (for example, oxygen, cardiopulmonary resuscitation equipment,

and defibrillator) to treat chronic respiratory disease.

Note: Nonphysician practitioners are eligible to supervise PR effective January 1, 2024.

As specified at 42 CFR 410.47(e), the number of PR sessions are limited to a maximum of 2 1-hour sessions per

day for up to 36 sessions over up to 36 weeks with the option for an additional 36 sessions over an extended

period of time if approved by the MACs.