Can someone please confirm that Pulmonary Hypertension is an excluded, non-covered DX for Pulmonary Rehab programs. Everything I have read indicates that it is a non-covered DX, among others, to use for patients in our Pulmonary Rehab program.
Thanks !
Generally, the following conditions are of priority in deciding NON-COVERAGE for Pulmonary Rehab Programs:
-Dementia/organic brain syndrome/disabling stroke
-Unstable cardiac disease including angina, arrhythmia and CHF (Left Ventricular failure)
-Ejection fraction < 20%
-Acute or unstable medically uncompensated cor pulmonale
-Metastatic cancer
-Morbid obesity (BMI > 39)
-Pulmonary hypertension
-Recent myocardial infarction
-Severe arthritis
-Severe psychiatric disease
-Substance abuse
-Unstable angina
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Special Note:
It has been under the LCDs that certain MACs have issued coverage policies for pulmonary rehab programs. But those coverage policies are applicable only to the area of a MAC’s jurisdiction. Current local pulmonary rehab policies can and do vary from jurisdiction to jurisdiction. MACs also have the discretion to rescind LCDs, and in recent years there have been several pulmonary rehab policies that have been revoked.
