Pulmonary Rehabilitation Reimbursement Toolkit

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. 

Resource Redisgn

We've teamed up with the American Association for Respiratory Care, American Thoracic Society and American College of Chest Physicians to design 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. Check out this new offering now to pick up…

  • 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 This Source

Help make necessary changes to PR charges by sharing this source, summarized here, with your administrators. Our national societies have put together a one-page resource to further clarify key Medicare reimbursement updates and strategies as well as important scientific advances. 

Secure a Spot

Tools, Tips, and Support to Improve Pulmonary Rehabilitation Payment

September 1, 2022 | 12:00 PM – 1:00 PM CT
Presented by: Susan Flack, RN, MS; Chris Garvey FNP, MSN, MPA, MAACVPR; and Debbie Koehl, MS,RRT-NPS, AE-C, FAARC

Join us on Thursday, September 1, for a can't-miss webinar! Throughout this session, attendees will have the opportunity to hear from a long list of PR experts as they walk through the ins and outs of this brand-new toolkit. Along the way, attendees will also learn how and why health professionals should take action to improve their charges.

Learning Objectives:

  1. Describe key elements of pulmonary rehabilitation reimbursement including Medicare rules and their interpretation and application
  2. Understand what’s important about the new comprehensive PR billing codes
  3. Review strategies to understand and use your hospital chargemaster
  4. Successfully work with billing and finance leads
  5. Develop a system for monitoring billing, charges, and payment to assess and confirm financial outcomes.

How to View Live Webinar

  1. Proceed through this registration process
  2. Receive confirmation email and click on Zoom link
  3. Complete registration on Zoom registration page
  4. You will receive an email from Zoom on the day of the webinar which contains the link to view the live webinar

CE Credit

No CEU will be offered through this webinar. 

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