Medicare Advantage Organization Coverage of Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease

Posted November 15, 2017

Effective immediately, the Centers for Medicare & Medicaid Services (CMS) has determined the cost and reimbursement for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) will be covered, for calendar years 2017 and 2018 only, by original fee-for-service Medicare. Providers should bill necessary SET items and services obtained by beneficiaries enrolled in Medicare Advantage plans to original fee-for-service Medicare. For 2019 and subsequent years, providers should plan to bill SET items and services to the beneficiaries’ Medicare Advantage plan unless notified otherwise.

Consistent with §1862(a)(1)(A) of the Social Security Act, Medicare Administrative Contractors will consider whether SET for PAD services are reasonable and necessary and reimbursable by original Medicare for Medicare beneficiaries enrolled in Medicare Advantage plans in calendar years 2017 and 2018.

For more information, refer to the article on the CMS website.