January 14, 2022
Summary of 2022 Medicare Regulation Changes
In case you missed it, here are the signifiant changes in Medicare regulations that affect cardiopulmonary rehablitation in 2022. This is also available in a Fact Sheet on AACVPR Central.
Rules That Apply to Cardiac, Intensive Cardiac and Pulmonary Rehabilitation
- Virtual direct supervision is currently scheduled to expire December 31, 2022. 86 FR 65248
- Virtual delivery of hospital-based cardiac, intensive cardiac, and pulmonary rehabilitation sessions using real-time audio-visual communications technology are scheduled to cease being allowed at the time the public health emergency (PHE) expires. 86 FR 63747
- The medical director, any staff physician, working in PR, CR, ICR program who is involved in patient’s care and has knowledge related to patient’s condition, or the patient’s treating and or/referring physician may establish, review and sign ITPs. 86 FR 65245
- A separately billable evaluation and management (E/M) service may be furnished in connection with establishing and signing the initial ITP before or on the first day of PR or CR/ICR by the medical director or other PR or CR/ICR staff physicians, when appropriate and when all E/M (professional) billing requirements are met. 86 FR 65245
- The initial ITP does not need a second review and signature by the medical director if it was developed by different physician. The medical director or other physician working in the program, in consultation with staff, may revise the ITP as needed to ensure the plan is appropriately individualized, regardless of which physician establishes and signs the plan. 86 FR 65245
- Clarification (not new): Outcomes assessments may be performed by either the physician or PR and CR/ICR staff. 86 FR 65245
Rules that Apply to Pulmonary Rehabilitation
- Pulmonary rehabilitation no longer requires “direct patient contact”. 86 FR 65249-50
- PR will be covered for beneficiaries who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks. The 4-week time frame may begin with symptom onset. (Please note that this added diagnosis does not fall under the COPD diagnosis, so COPD eligibility criteria requirements, including PFTs, do not apply.) 86 FR 65247, 65250
- HCPCS G code G0424 is replaced by two new PR CPT codes:
- CPT 94625: Outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)
- CPT 94626: Outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session) 86 FR 65114
In Case You Missed It: The recording of the December 2021 webinar, “2022 Medicare Regulations & Legislative Priorities – A Look Ahead” presented by Karen Lui, RN, MS and Susan Flack, RN, MS is avaliable in the AACVPR Learning Center. In this webinar, new or improved ways to deliver more patient-centric services while incorporating these changes are discussed.
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