CMS Pub. 100-04, ch. 32, § 140.4.1

The following are the applicable HCPCS codes for PR:

Effective January 1, 2010 through December 31, 2021

G0424 (Pulmonary rehabilitation, including exercise (includes monitoring), per hour, per

session)

Effective January 1, 2022

94625 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation;

without continuous oximetry monitoring (per session))

94626 (Physician or other qualified health care professional services for outpatient pulmonary rehabilitation;

with continuous oximetry monitoring (per session)

Effective for dates of service on or after January 1, 2010, hospitals and practitioners may report a maximum of

2 1-hour sessions per day. In order to report one session of PR in a day, the duration of treatment must be at

least 31 minutes. Two sessions of PR may only be reported in the same day if the duration of treatment is at

least 91 minutes. In other words, the first session would account for 60 minutes and the second session would

account for at least 31 minutes, if two sessions are reported. If several shorter periods of PR are furnished on a

given day, the minutes of service during those periods must be added together for reporting in 1-hour session

increments.

Example: If the patient receives 20 minutes of PR in the day, no PR session may be reported because less than

31 minutes of services were furnished.

Example: If a patient receives 20 minutes of PR in the morning and 35 minutes of PR in the afternoon of a

single day, the hospital or practitioner would report 1 session of PR under 1 unit of HCPCS code/CPT code for

the total duration of 55 minutes of PR on that day.

Example: If the patient receives 70 minutes of pulmonary rehabilitation services in the morning and 25 minutes

of pulmonary rehabilitation services in the afternoon of a single day, the hospital or practitioner would report

two sessions of pulmonary rehabilitation services under the HCPCS G-code/CPT codes because the total

duration of pulmonary rehabilitation services on that day of 95 minutes exceeds 90 minutes.

Example: If the patient receives 70 minutes of pulmonary rehabilitation services in the morning and 85 minutes

of pulmonary rehabilitation services in the afternoon of a single day, the hospital or practitioner would report

two sessions of pulmonary rehabilitation services under the HCPCS G-code/CPT codes for the total duration of

pulmonary rehabilitation services of 155 minutes. A maximum of two sessions per day may be reported,

regardless of the total duration of pulmonary rehabilitation services.