KMAP BULLETIN: Coverage of Outpatient Pulmonary Rehabilitation
Date: 12/07/22
KMAP GENERAL BULLETIN 22324 (PDF)
Effective with dates of service on and after January 1, 2023, outpatient Pulmonary Rehabilitation services will be covered by Kansas Medicaid.
Pulmonary rehabilitation includes all the following components:
- Physician-prescribed exercise (some aerobic exercise must be included in each pulmonary rehabilitation session).
- Education or training closely and clearly related to the individual’s care and treatment which is tailored to the individual’s needs, including information on respiratory problem management and, if appropriate, brief smoking cessation counseling.
- Psychosocial assessment, including written evaluation of an individual’s mental and emotional functioning as it relates to the member’s rehabilitation or respiratory condition.
- Outcome’s assessment, including beginning and end evaluations, objective clinical measures of effectiveness, and self-reported measures of shortness of breath and behavior.
- An individualized treatment plan detailing how components are utilized for each patient. The individualized treatment plan must be established, reviewed, and signed by a physician who is involved in the patient’s care and has knowledge related to his or her condition, every 30 days.
| CPT | Medicaid Rate |
|---|---|
| 94625 | $13.71 |
| 94626 | $20.18 |
Note: The effective date of the policy is January 1, 2023. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.