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Office-Based PAD Evaluation and Supervised Exercise Therapy (SET) Covered by Medicare (Michigan-Ohio Model)


Robert Ross, PA-C, President-Clinical Affairs, Medical Education and Research Development,Triad Diagnostic Technologies

Abstract Number
AMP 2018-17

Purpose: A Supervised Exercise Therapy (SET) program must be conducted in a hospital outpatient setting or in a physician’s office and under the ‘direct supervision’ of a physician or physician assistant, nurse practitioner, or clinical nurse specialist who must be trained in both basic and advanced life support techniques. Physical therapists not practicing in these settings are not covered at this time. Currently, CPT Code 93668 covers Peripheral Arterial Disease (PAD) Rehabilitation. At this point, we are unsure whether a new code will be developed or if code 93668 will be revised. We are expecting more information when CMS releases the final National Coverage Determination contractor instructions and will share that information as it becomes available. Materials and Methods: Key points in the 2014 clinical evidence update included management of intermittent claudication; exercise programs; and the association of supervised exercise with increases in MWD (Maximal Walking Distance) compared with home-based or other unsupervised exercise programs. Additionally,supervised exercise is associated with greater increases in walking distance in people with aorto-iliac disease than either stenting or optimum medical care, and supervised exercise appears to be more cost-effective than either angioplasty alone or supervised exercise plus angioplasty in people with intermittent claudication (IC) due to femoropopliteal occlusion. Results: The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions over a 12-week period are covered if all of the following components of a SET program are met. Conclusions: PAD affects 12%-20% of Americans age 60 and older, and the incidence of PAD increases considerably with age. Supervised exercise therapy has been demonstrated to be an effective therapy to lessen the symptoms of IC and improve walking distance in patients with PAD in numerous trials. Stakeholders such as the American Heart Association (AHA) have long recommended supervised exercise as a first line, non-invasive, low-risk therapy for individuals with PAD who suffer from claudication. Despite the disease burden and the substantial evidence supporting supervised exercise therapy as a safe and effective treatment for PAD, it is currently covered by Medicare.

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