tci Part B Insider - 2014 Issue 15

Reader Question: Breathe Easy When Billing for Pulmonary Rehab

Question: Is it appropriate for me to bill for pulmonary rehab using G0424 for non-COPD patients? If not, what should we use, and what would the appropriate modifiers be? Answer: No. Medicare only covers G0424 (Pulmonary rehabilitation, including exercise [includes monitoring], one hour, per session, up to two sessions per day) when the pulmonary rehab services are provided to a patient with moderate to very severe COPD (defined as GOLD classification II, III and IV) can be covered by G0424. For any other conditions, you cannot collect for the pulmonary rehab services with G0424. For all non-COPD patients, you...

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