CMS Regulations for SET

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May 11, 2018: CMS corrected regulations for SET.

SET for PAD may be provided in a hospital outpatient setting or a physician office setting, as was the intention of CMS before a technical error occurred in April

MM10295 – Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10295.pdf


Health Policy & Reimbursement Update
CMS Coverage Policy on Supervised Exercise Therapy for Peripheral Artery Disease (PAD) – April 10, 2018

On April 3, 2018, CMS (Centers for Medicare & Medicaid Services) changed the National Coverage Determination (NCD) 20.35 for Supervised Exercise Therapy (SET) for Peripheral Artery Disease (PAD) to exclude the hospital outpatient setting as an allowed setting. This was immediately questioned by AACVPR and partner societies, ACC and AHA, who had initially requested coverage of SET for PAD patients and worked with multiple professional societies toward the final Medicare coverage policy for SET that was effective May 25, 2017.

CMS clarified today the hospital outpatient settings were erroneously excluded from the revised MLN article and revised claims processing instructions. CMS is currently working on the quickest resolution to add hospital outpatient settings as an acceptable place of service and expects to have that correction completed long before the July implementation date CMS apologizes for any confusion this error caused.

MACs (Medicare Administrative Contractors) had been informed by CMS of the change in policy and this week the (erroneous) regulation change was was communicated by some MACs to hospitals in those regions. Your hospital should continue planning and providing SET PAD. AACVPR will post the corrected regulations (NCD, Claims Processing manual, MLN Matters) when they are available.

Please direct any questions to aacvpr@aacvpr.org.