Pulmonary Rehabilitation (PR) financial stability and access require that charges reflect the complexity of services as well as the billable and unbillable costs of comprehensive care. As part of the Medicare PR benefit in 2010, G0424 was created as a new bundled code that differed significantly from existing 15-minute codes like G0237 and G0238. Medicare has advised that failure to adequately capture costs of services using bundled codes will result in inadequate payment.
After 10 years of inadequate PR, multiple societies joined together to develop two new CPT codes 94625 (with and without continuous pulse oximetry monitoring). These are bundled, comprehensive codes that reflect the complexity of PR and include numerous billable and non-billable services. These new codes, which replaced G0424, closely resemble cardiac rehabilitation (CR) codes. Additionally, they support parity of PR and CR charges in pursuit of adequate and equitable payment for PR services.
Download the Toolkit
We've teamed up with the American Association for Respiratory Care, American Thoracic Society and American College of Chest Physicians to publish a toolkit that gives hospital-based providers tools, insights and resources regarding payment for Medicare’s comprehensive pulmonary rehabilitation (PR) benefit implemented by the Centers for Medicare & Medicaid Services (CMS) and new CPT codes for PR that became effective January 1, 2022. It addresses:
- Strategies to address Medicare payment
- Ways to establish appropriate charges
- Methodologies to calculate fair and responsible charge for 94625/94626
- Examples of uncompensated services
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Share The Toolkit
Help make necessary changes to PR charges by using this source, summarized here, and sharing it with your PR colleagues. Our national societies have put together a one-page resource to share with hospital CFOs and billing leads to further clarify key Medicare reimbursement updates and strategies as well as important scientific advances.