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Pulmonary Rehabilitation CPT Code 94799 and Revenue Code 949

Description of Pulmonary Rehabilitation Program

Pulmonary rehabilitation may be defined as an art of medical practice in which an individually tailored, multidisciplinary program is formulated which, through accurate diagnosis, therapy, emotional support, and education, stabilizes or reverses both the physio and psychopathology of pulmonary disease. This program attempts to return the patient to the highest possible functional capacity allowed by his or her pulmonary handicap and overall life situation.

A Pulmonary Rehabilitation Program is designed to help patients with chronic lung disease live healthier and more productive lives. A well structured program allows patients to learn more about the disease and how to better manage it at home, while increasing their tolerance for activity.

Coverage and Billing

The primary diagnosis code to bill for Pulmonary Rehabilitation is V57.89. The secondary diagnosis code is the medical condition for which the rehabilitation is required, e.g., COPD.

Program admission qualifications:

A period of 30 hours within a six-week time frame is eligible for reimbursement under Major Medical Benefits on Alabama-written contracts for services rendered in an approved facility.

Benefits are provided for an initial history and physical examination by a physician qualified by training and experience in pulmonary diseases prior to admission to an approved program (as a separately billable service).

Benefits are provided for studies such as a spirogram, chest x-ray, EKG, blood gases, pulmonary function studies, CBC, and urinalysis unless such information is already available. These services are paid according to contract benefits.

For approval of pulmonary rehabilitation services, each facility should submit the following information to their Network Services Representative:

  1. Program specifications.
  2. Location of the program.
  3. Policy for handling medical emergencies.
  4. Availability of physician during operating hours.
  5. The name of the medical director of the program and qualifications/training.
  6. Staffing requirements, including staff-to-patient ratio.