G0424 is for CMS approved national pulmonary rehab program
The following response is from our CMS, Medical Review Staff regarding questions stated below. "Question #1: What is the ratio of Exercise Specialist to Pulmonary Rehab Patients when using CPT G0424? In other words, how many pulmonary rehab patients may an exercise specialist serve during a one hour rehab session? Answer: G0424 is for CMS approved national pulmonary rehab program, the description of this code does not limit or define the sessions to be individual or group. Therefore, there is no ratio standards at this time for this program however, please note that program is evolving with CMS change requests that are expected to final in the next couple of month. Additionally, the CFR requires that the treatment plans are individualized and "education or training closely and clearly related to the individual's care and treatment which is tailored to the individual's needs". Question #2: What codes must be used for pulmonary rehabilitation/pulmonary physical therapy and is there a difference between providing pulmonary rehabilitation in the MD office? Answer: Please note there is a difference in the codes of G0237, G0238, G0239 and G0424. The code G0424 is for pulmonary rehab program only. This program has limits on sessions and coverage for only specified CMS approved conditions. Additionally, requires following of specific list of program elements for this CMS approved pulmonary rehabilitation program. Please refer to 42 CFR 410.47 and Medicare Claims Processing Manual Publication 100-4 Chapter 32 section 140.4.1. G0237, G0238, and G0239 are for outpatient pulmonary services not the pulmonary rehab program. These HCPCS codes describe services for the improvement of respiratory function and may represent either "incident to" services or respiratory therapy services that may be appropriately billed in the CORF setting. When the services described by these G-codes are provided by physical therapists (PTs) or occupational therapists (OTs) 'treating respiratory conditions' , they are considered "therapy services" and must meet the other conditions for physical and occupational therapy. The PT or OT would use the appropriate HCPCS/CPT code(s) in the 97000 - 97799 series and the corresponding therapy modifier, GP or GO, Must Be Used. Reference: Medicare Claims Processing Manual Publication 100-4 Chapter 5 section 20 subsection C.
