Coverage of Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) for Blue Cross Medicare Advantage PPOSM and Blue Cross Medicare Advantage HMOSM
The Centers for Medicare and Medicaid Services (CMS) has determined the cost and reimbursement for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) will be covered, for calendar years 2017 and 2018 only, by original fee-for-service Medicare. Providers should bill necessary SET items and services obtained by beneficiaries enrolled in MA plans to original fee-for-service Medicare. For 2019 and subsequent years, providers should plan to bill SET items and services to the beneficiaries’ MA plan unless notified otherwise.
Consistent with §1862(a)(1)(A) of the Act, Medicare Administrative Contractors will consider whether SET for PAD services are reasonable and necessary and reimbursable by original Medicare for Medicare beneficiaries enrolled in MA plans in calendar year 2017 and 2018.
Please review the CMS guidance article, as soon as possible by clicking on the Medicare-Learning-Network-MLN Matters Article related to SET & PAD.