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Washington Update: In Big Win, CMS to Cover Exercise Therapy

In a significant victory for PAD patients and their surgeons, the Centers for Medicare & Medicaid Services is offering national Medicare coverage for supervised exercise therapy (SET) beyond the hospital setting to include a physician’s office or a hospital outpatient setting.

"The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD)," the CMS said in issuing a National Coverage Determination. Up to 36 sessions over a 12-week period are covered if all of the following components of a SET program are met:

The SET program must:

  • Consist of sessions lasting 30-60 minutes comprising a therapeutic exercise-training program for PAD in patients with claudication;
  • Be conducted in a hospital outpatient setting, or a physician’s office;
  • Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD; and
  • Be under the direct supervision of a physician (as defined in 1861(r) (1)), physician assistant, or nurse practitioner/clinical nurse specialist (as identified in 1861(aa)(5)) who must be trained in both basic and advanced life support techniques.

Experts have pointed out a significant portion of Medicare beneficiaries suffer from PAD. "We are delighted that the CMS has taken this important step for our patients," said Dr. Ronald Fairman, SVS president at the time of the decision. "PAD is a common condition and low-cost remedies such as supervised exercise can be of great help for patients in the early stages."

This ruling might not have happened without the hard work of everyone on the SVS advocacy team to make the case that "SET is a win-win for government agencies, physicians, and most importantly, patients," Fairman said.

"Our Policy and Advocacy Council and Government Relations Committee have once again ensured that SVS input and concerns were recognized by the CMS and were part of the national dialogue. This solid victory points out the importance of our Political Action Committee and its efforts to bring our voice to the table. This is a big win for the SVS!"

He congratulated Political Action Committee Chair Dr. Randall DeMartino; Government Relations Chair Dr. Michael Dalsing; Policy and Advocacy Committee Chair Dr. Sean Roddy; and Pam Phillips, director of the SVS Washington Office, plus all others who worked hard to advocate for expansion of therapy beyond the hospital setting.

Read the full CMS statement at vsweb.org/SETmemo.