The CMS issued a final decision memo announcing it will cover supervised exercise therapy for Medicare beneficiaries with intermittent claudication for treatment of symptomatic peripheral artery disease.
The final decision comes less than 3 months after the agency issued a proposed decision memo stating that the evidence was sufficient for such coverage.
Coverage can be obtained for up to 36 sessions over 12 weeks for programs that meet the following criteria: sessions of 30 to 60 minutes comprising a therapeutic exercise-training program for PAD in claudicants; located in a hospital outpatient setting or physician’s office; and delivered by qualified personnel trained in exercise therapy for PAD who are supervised by a physician, physician assistant, nurse practitioner or clinical nurse specialist trained in basic and advanced life-support techniques.
To obtain a referral, a patient must have a face-to-face visit with the physician responsible for his or her PAD treatment and receive information about CVD and PAD risk factor reduction.
Medicare administrative contractors may cover an additional 36 sessions at their discretion; an additional referral is required.
The American Heart Association released a statement from CEO Nancy Brown praising the decision.
“We are so pleased that patients with PAD will now be able to receive supervised exercise therapy through Medicare,” she said. “PAD affects 12% to 20% of Americans age 60 and older, and the incidence of PAD increases considerably with age. Medicare beneficiaries, a significant portion of which have PAD, will benefit considerably from participating in supervised exercise therapy sessions. Evidence shows this therapy can improve quality of life for patients and enhance clinical outcomes. The [AHA], along with many other stakeholders, have long recommended supervised exercise as a firstline, noninvasive, low-risk therapy for individuals with PAD. The association has advocated for it since our first PAD guidelines were issued in 2005, and just last year, we filed a national coverage determination request asking CMS for this exact outcome. We couldn’t be more thrilled with [the] decision that will give more Americans the access they need to this important treatment option.”
Brown is an employee of the American Heart Association.