March 14, 2017
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CMS: Evidence sufficient to cover supervised exercise therapy for intermittent claudication

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The CMS issued a proposed decision memo stating that the evidence is sufficient for coverage of supervised exercise therapy for Medicare beneficiaries with intermittent claudication for treatment of symptomatic peripheral artery disease.

Under the proposal, to be covered, a program must include a therapeutic exercise-training program with sessions lasting 30 to 60 minutes, with three sessions per week for up to 12 weeks.

The program would have to be conducted in a hospital or outpatient hospital setting by qualified auxiliary personnel trained in basic and advanced life support techniques and in exercise therapy for PAD, under the direct supervision of a physician.

The proposal would allow Medicare administrative contractors to cover supervised exercise therapy beyond 36 sessions over 12 weeks for as long as an additional 36 sessions over time; additional sessions would require a second referral and a justification.

Supervised exercise therapy would not be covered in patients with absolute contraindications to exercise, including exercise-limiting CVD, amputation or wheelchair confinement.

To obtain a referral for supervised exercise therapy, a patient would need a face-to-face meeting with the physician responsible for the treatment of their PAD to review CVD and PAD risk factor reduction, possibly including education, counseling, behavioral interventions and outcome assessments, according to the memo.

The proposal comes after a meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) in July 2015, in which members of the MEDCAC panel expressed moderate confidence that there was sufficient evidence to support coverage of at least one intervention to improve intermittent claudication in the short and long term.

In the initial 30-day public comment period for the proposal in September and October 2016, CMS received 103 comments, all of which supported Medicare coverage for supervised exercise therapy for the treatment of symptomatic PAD.

CMS is now accepting comments on the proposed decision, and will respond to the comments for a final decision. The memo did not give a timetable for the final decision. An online comment form is available on the memo’s page at www.cms.gov. – by Erik Swain