Commercial
Advanced Search

Pulmonary Rehabilitation
10.04.01m

Policy

MEDICALLY NECESSARY

 Outpatient pulmonary rehabilitation is considered medically necessary and, therefore, covered when all of the following criteria are met:
  • The individual has moderate to moderately severe respiratory impairment due to one of the following conditions:
    • Chronic pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD], asthma, emphysema, bronchiectasis, cystic fibrosis, chronic bronchitis, interstitial lung disease)
    • Other conditions that may cause impaired pulmonary function (e.g., muscular dystrophy, Guillain-Barré syndrome, sarcoidosis)
  • The individual continues to be symptomatic (e.g., dyspnea, fatigue) despite optimal medical management (e.g., oxygen, bronchodilators)
  • The individual presents with reduced exercise tolerance, which affects performance of activities of daily living
In addition to the above conditions, outpatient pulmonary rehabilitation is considered medically necessary and, therefore, covered for either of the following:
  • Pre- and post–​lung transplantation
  • Pre- and post–lung volume reduction surgery
NOT MEDICALLY NECESSARY

Outpatient pulmonary rehabilitation is considered not medically necessary and, therefore, not covered when the above criteria are not met because the available published peer-reviewed literature does not support its use in the treatment of illness or injury.

The continued treatment of an individual when the maximum therapeutic goals of a treatment plan have been achieved and no additional functional improvement is apparent or expected to occur, sometimes referred to as maintenance therapy, is considered not medically necessary and, therefore, not covered because the provision of services ceases to be of therapeutic value.

EXPERIMENTAL/INVESTIGATIONAL

Home-based pulmonary rehabilitation is considered experimental/investigational and, therefore, not covered because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines

Pulmonary rehabilitation programs should meet all of the following requirements:
  • The setting should have the necessary cardiopulmonary, emergency, diagnostic, and therapeutic life-saving equipment (e.g., oxygen, cardiopulmonary resuscitation equipment, defibrillator).
  • A physician should be immediately available and accessible for medical consultations and emergencies at all times that the pulmonary rehabilitation services are being furnished.
  • The physician supervising the pulmonary rehabilitation program should have expertise in the management of individuals with respiratory pathophysiology and be involved substantially, in consultation with staff, in directing the progress of individuals in the pulmonary rehabilitation program.
  • The pulmonary rehabilitation program must include all of the following components:
    • Professional provider–​prescribed exercise. This physical activity includes techniques such as exercise conditioning, breathing retraining, and step and strengthening exercises. Some aerobic exercise must be included in each pulmonary rehabilitation session. Both low- and high-intensity exercise is recommended to produce clinical benefits, and a combination of endurance and strength training should be conducted at least twice per week.
    • Education or training. This should be closely and clearly related to the individual's care and treatment and tailored to the individual's needs, including information on respiratory problem management and, if appropriate, brief smoking cessation counseling. Any education or training must assist in achievement of individual goals toward independence in activities of daily living, adaptation to limitations, and improved quality of life (QoL).
    • Psychosocial assessment. This assessment means a written evaluation of an individual’s mental and emotional functioning as it relates to the individual’s rehabilitation or respiratory condition. It should include: (1) an assessment of the aspects of the individual’s family and home situation that affect the individual’s rehabilitation treatment, and (2) a psychological evaluation of the individual’s response to, and rate of progress under, the treatment plan. Periodic re-evaluations are necessary to ensure that the individual’s psychosocial needs are being met.
    • Outcomes assessment. These should include: (1) beginning and end evaluations based on patient-centered outcomes, which are conducted by the professional provider at the start and end of the program, and (2) objective clinical measures of the effectiveness of the pulmonary rehabilitation program for the individual patient, including exercise performance and self-reported measures of shortness of breath and behavior. The assessments should include clinical measurements such as the 6-minute walk, weight, exercise performance, self-reported dyspnea, behavioral measures (supplemental oxygen use, smoking status), and a QoL​ assessment.
    • Individualized treatment plan describing the individual’s diagnosis and detailing how components are utilized for each individual. The plan must be established, reviewed, and signed by a professional provider every 30 days. The plan may initially be developed by the referring professional provider or the pulmonary rehabilitation professional provider. If the plan is developed by a referring professional provider who is not the pulmonary rehabilitation professional provider, the pulmonary rehabilitation professional provider must also review and sign the plan prior to initiation of the pulmonary rehabilitation program. It is expected that the supervising professional provider would have initial, direct contact with the individual prior to subsequent treatment by ancillary personnel, and also have at least one direct contact in each 30-day period. The plan must have written specificity regarding type, amount, frequency, and duration of pulmonary rehabilitation items and services furnished to the individual, and specify the appropriate mix of services for the individual's needs. The plan must also include measurable and expected outcomes and estimated timetables to achieve these outcomes.
BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, pulmonary rehabilitation is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met. However, services that are identified in this policy as not medically necessary, as experimental/investigational, or as benefit contract exclusions are not eligible for coverage or reimbursement by the Company.

Medical necessity determination applies only if the pulmonary rehabilitation benefit exists and has not been exhausted, and no contract exclusions are applicable. For individuals enrolled in the Company's commercial products, individual benefits must be verified as limitations may apply.

BILLING GUIDELINES

When part of a comprehensive pulmonary rehabilitation program, providers should report the specific Healthcare Common Procedure Coding System (HCPCS) Level II code that describes pulmonary rehabilitation as a program.

The components of pulmonary rehabilitation, as part of a multidisciplinary treatment, may include services performed by a variety of professional therapy disciplines and should be reported using the most appropriate billing codes for the services performed.

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Description

Pulmonary rehabilitation (PR), as defined by the American Thoracic Society/European Respiratory Society (ATS/ERS) and endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), is a comprehensive intervention based on a thorough assessment followed by individually tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of individuals with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.

Individuals with chronic respiratory diseases other than chronic obstructive pulmonary disease (COPD), e.g., cystic fibrosis, asthma, bronchiectasis, and other chronic conditions, have also been shown to benefit from structured PR programs; however, these conditions have not been studied as extensively as COPD. This is largely because of the lower prevalence of these conditions, and that the published literature mainly consists of observational studies, e.g., case series, case reports, and so on. Nonetheless, the use of this intervention for these individuals is recommended by some professional societies. In a joint statement issued in 2013, the ATC/ERS stated that PR may be valuable for conditions other than COPD in which respiratory symptoms are associated with reduced health-related quality of life (QoL) or diminished functional capacity.

PR is also recommended for individuals awaiting lung volume–reduction surgery and lung transplantation. In these individuals, the intervention should be offered presurgery for stabilization, improvement of activity tolerance, and instruction in techniques beneficial to postsurgery​ recovery. The demonstrated outcomes of PR noted by the AACVPR include:
  • Reduced dyspnea and fatigue
  • Increased exercise performance
  • Enhanced performance of activities of daily living
  • Improved anxiety and depression symptoms
PR may be initiated during an inpatient stay and is typically offered in an outpatient setting. Although PR may be available in the home setting, based on a review of available published literature, the impact of a comprehensive home-based PR program on health outcomes is mixed.

PEER-REVIEWED LITERATURE


PR programs have primarily been studied in, and utilized by, individuals with COPD and have been shown to significantly improve outcomes. In a meta-analysis of nine studies reporting on 432 individuals with recently exacerbated COPD, Misspelled WordPuhan et al. (2011) compared outcomes in individuals undergoing PR with those undergoing conventional therapy. The primary outcome of interest was subsequent hospital admissions postintervention, while secondary outcomes included mortality, health-related QoL, and exercise capacity. In pooled analysis of the outcomes, the authors found that at 25 weeks postintervention, individuals undergoing PR experienced significantly fewer subsequent hospital admissions compared with those undergoing conventional therapies (odds ratio, 0.22; 95% confidence interval, 0.08–0.58). Additionally, the study found that PR significantly improved secondary outcomes of interest such as QoL, fatigue, dyspnea. The authors concluded that these results provide strong evidence that PR is a highly effective and safe intervention to reduce hospital admissions, mortality, and other outcomes in individuals with COPD who have recently suffered an exacerbation of their condition.


A meta-analysis was performed in 2015 by McCarthy et al. involving 3822 individuals in 65 randomized controlled trials comparing the effects of PR versus usual care on health-related QoL and functional and maximal exercise capacity in persons with COPD. The authors concluded that PR relieves dyspnea and fatigue, improves emotional function, and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related QoL and exercise capacity.


A systematic review of six studies involving 1305 individuals was performed in 2017 by Hoffman et al. to evaluate the effects of PR in candidates for lung transplantation. The studies included in this review showed that PR is an effective treatment option for individuals on the waiting list for lung transplantation and can improve QoL and exercise capacity in those individuals. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates.


A meta-analysis was performed in 2018 by Cheng et al. to investigate the short- and long-term effects of PR in individuals with idiopathic pulmonary fibrosis (IPF). The outcomes of four randomized controlled trials (142 participants) were exercise capacity and health-related QoL. In individuals with IPF, PR showed short-term effects in enhancing exercise capacity and health-related QoL, while it had no detectable effects at long-term follow-up.


Yu et al. (2019) performed a systematic review of seven studies involving 190 individuals to evaluate the efficacy and safety of PR in individuals with IPF. The review suggested that PR may enhance exercise capacity and improve QoL in IPF individuals. PR may also delay the decline of lung function of individuals with IPF. However, further research should more fully assess the efficacy and safety of PR for IPF.


Misspelled WordDowman et al. (2021) performed a meta-analysis including 16 studies with 356 participants enrolled in PR and 319 as control participants comparing the beneficial effects on exercise capacity, symptoms, QoL, and survival compared with no PR in individuals with interstitial lung disease (ILD). The duration of PR ranged from 3 to 48 weeks. It was concluded that PR can be performed safely in people with ILD. PR probably improves functional exercise capacity, dyspnea and QoL in the short term, with benefits also probable in IPF. Improvements in functional exercise capacity, dyspnea, and QoL were sustained longer term. Dyspnea and QoL may be sustained in people with IPD. Further well-designed randomized trials are needed to determine the optimal exercise prescription, and to investigate ways to promote longer lasting improvements, particularly for people with IPF.​​

References

Agency for Healthcare Research and Quality (AHRQ). Benefits of Pulmonary Rehabilitation. Available at: https://effectivehealthcare.ahrq.gov/get-involved/nominated-topics/benefits-pulmonary-rehabilitation. Accessed March 5, 2026.

American Association of Cardiovascular and Pulmonary Rehabilitation. Pulmonary Rehabilitation Patient Resources. Available at: https://www.aacvpr.org/Pulmonary-Patient-Resources. Accessed March 5, 2026.

American Thoracic Society (ATS) Pulmonary rehabilitation. Patient Education. [ATS Web site]. Available at: https://www.thoracic.org/patients/patient-resources/resources/pulmonary-rehab.pdf. Accessed March 5, 2026.

Beauchamp MK, Janaudis-Ferreira T, Goldstein RS et al. Optimal duration of pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease - a systematic review. Chron Respir Dis. 2011;8(2):129-140.

Beling J. Improved health-related quality of life after lung volume reduction surgery and pulmonary rehabilitation. Cardiopulm Phys Ther J. 2009;20(3):16-22.

Benzo R, Wigle D, Novotny P, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer. 2011;74(3):441-445.

Bolton CE, Bevan-Smith EF, Blakey JD, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2013;68(Suppl 2):ii1-30.


Bondarenko J, Dal Corso S, Dillon MP, et al. Clinically important changes and adverse events with centre-based or home-based pulmonary rehabilitation in chronic respiratory disease: A systematic review and meta-analysis. Chron Respir Dis. 2024;21:14799731241277808.

Bradley A, Marshall A, Stonehewer L, et al. Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. Eur J Cardiothorac Surg. 2013;44(4):e266-271.

Carr SJ, Hill K, Brooks D, et al. Pulmonary rehabilitation after acute exacerbation of chronic obstructive pulmonary disease in patients who previously completed a pulmonary rehabilitation program. J Cardiopulm Rehabil Prev. 2009;29(5):318-324.

Centers for Medicare & Medicaid Services (CMS). Medicare Benefit Policy Manual. Chapter 15: Covered medical and other health services. §231: Pulmonary rehabilitation services furnished on or after January 1, 2024. [CMS Web site]. 07/25/2025. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf. Accessed March 5, 2026.

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 32: Billing requirements for special services. §140.4: Pulmonary rehabilitation services furnished on or after January 1, 2024. [CMS Web site]. 01/30/2026. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c32.pdf. Accessed March 5, 2026. 

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 240.8: Pulmonary rehabilitation services. [CMS Web site] Original: 9/25/07. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=320&ncdver=1&bc=AgAAgAAAAAAA&. Accessed March 5, 2026.

Cheng L, Tan B, Yin Y, et al. Short- and long-term effects of pulmonary rehabilitation for idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Clin Rehabil. 2018;32(10):1299-1307.

Company Benefit Contracts.

COPD Working Group. Pulmonary rehabilitation for patients with chronic pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser. 2012;12(6):1-75.

Dowman L, Hill CJ, May A et al. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021;2:CD006322.


Edvardsen E, Skjonsberg OH, Holme I, et al. High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax. 2015;70(3):244-250.

Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348(21):2059-2073.

Fuller LM, Button B, Tarrant B, et al. Longer versus shorter duration of supervised rehabilitation after lung transplantation: a randomized trial. Arch Phys Med Rehabil. 2017;98(2):220-226.e223.

Gaunaurd IA, Gomez-Marin OW, Ramos CF, et al. Physical activity and quality of life improvements of patients with idiopathic pulmonary fibrosis completing a pulmonary rehabilitation program. Respir Care. 2014;59(12):1872-1879.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2025 Report. Available at: https://goldcopd.org/2025-gold-report/. Accessed on March 5, 2026.

Gottlieb V, Lyngso AM, Nybo B, et al. Pulmonary rehabilitation for moderate COPD (GOLD 2)--does it have an effect? COPD. 2011;8(5):380-386.


Grünig E, Eichstaedt C, Barberà JA, et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J. 2019;53(2):1800332. 

Guell MR, Cejudo P, Ortega F, et al. Benefits of long-term pulmonary rehabilitation maintenance program in patients with severe chronic obstructive pulmonary disease. three-year follow-up. Am J Respir Crit Care Med. 2017;195(5):622-629.

Hoffman M, Chaves G, Ribeiro-Samora GA, et al. Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review. BMJ Open. 2017;7(2):e013445.


Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2021;18(5):e12-e29. 

Jackson RM, Gomez-Marin OW, Ramos CF, et al. Exercise limitation in IPF patients: a randomized trial of pulmonary rehabilitation. Lung. 2014;192(3):367-376.

Jacome CI, Marques AS. Pulmonary rehabilitation for mild COPD: a systematic review. Respir Care Respir Care. 2014;59(4):588-594.

Kozu R, Senjyu H, Jenkins SC, et al. Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary diseases. Respiration. 2011;81(3):196-205.

Langer D, Burtin C, Schepers L, et al. Exercise training after lung transplantation improves participation in daily activity: a randomized controlled trial. Am J Transplant. 2012;12(6):1584-1592.

Lee AL, Hill CJ, McDonald CF, et al. Pulmonary rehabilitation in individuals with non-cystic fibrosis bronchiectasis: a systematic review. Arch Phys Med Rehabil. 2017;98(4):774-782 e771.


Liu X-D, Jin H-Z, Ng B-P, et al. Therapeutic effects of qigong in patients with COPD: a randomized controlled trial. Hong Kong J Occup Ther. 2012;22(1):38-46.

Liu XL, Tan JY, Wang T, et al. Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Rehabil Nurs. 2014;39(1):36-59.

Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869-878.

McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2(2):CD003793.

Morano MT, Araujo AS, Nascimento FB, et al. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. Arch Phys Med Rehabil. 2013;94(1):53-58.

Munro PE, Holland AE, Bailey M, et al. Pulmonary rehabilitation following lung transplantation. Transplant Proc. 2009;41(1):292-295.

Neves LF, Reis MH, Goncalves TR. Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Cad Saude Publica. 2016;32(6).

Ong HK, Lee AL, Hill CJ, et al. Effects of pulmonary rehabilitation in bronchiectasis: a retrospective study. Chronic Respir Dis. 2011;81(1):21-30.

Puhan MA, Gimeno-Santos E, Cates CJ, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016;12:CD005305.

Puhan MA, Gimeno-Santos E, Scharplatz M, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;(10):CD005305.

Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and the European Respiratory Society. Ann Intern Med. 2011;155(3):179-191.

Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131(5 Suppl):4S-42S.


Rochester CL, Alison JA, Carlin B, et al. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2023;208(4):e7-e26.

Roman M, Larraz C, Gomez A, et al. Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial. BMC Fam Pract. 2013;14:21.

Rugbjerg M, Iepsen UW, Jorgensen KJ, et al. Effectiveness of pulmonary rehabilitation in COPD with mild symptoms: a systematic review with meta-analyses. Int J Chron Obstruct Pulmon Dis. 2015;10:791-801.

Salhi B, Troosters T, Behaegel M, et al. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. Chest. 2010;137(2):273-279.

Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64.


Van Wetering CR, Hoogendoorn M, Mol SJ, et al. Short- and long-term efficacy of a community-based COPD management program in less advanced COPD: a randomised controlled trial. Thorax. 2010;65(1):7-13.

Vieira D, Maltais F, Bourbeau J. Home-based pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2010;16(2):134-143.

Wickerson L, Mathur S, Brooks D. Exercise training after lung transplantation: a systematic review. J Heart Lung Transplant. 2010;29(5):497-503.

William D-C M, Puhan MA, Harrison SL, et al. Pulmonary rehabilitation and severe exacerbation of COPD: solution or white elephant. ERJ Open Res. 2015;1(2):0050-2015.

Wilson AM, Browne P, Olive S, et al. The effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomised controlled trial. BMJ Open. 2015;5(3):e005921.


Yu X, Li X, Wang L, et al. Pulmonary rehabilitation for exercise tolerance and quality of life in IPF patients: a systematic review and meta-analysis. Biomed Res Int. 2019; March 21;2019:8498603. ​
 


Coding

CPT Procedure Code Number(s)
94625, 94626
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
N/A
HCPCS Level II Code Number(s)
S9473 Pulmonary rehabilitation program, non-physician provider, per diem
Revenue Code Number(s)
0948 Other Therapeutic Services - Pulmonary Rehabilitation



Coding and Billing Requirements

Policy History

Revisions From 10.04.01m:​​
​04/29/2026
​This policy has been reviewed and reissued to communicate the Company’s continuing position on pulmonary rehabilitation.​​
​04/02/2025
​
​This p​olicy has been reviewed and reissued to communicate the Company’s continuing position on pulmonary rehabilitation.​​​
​10/30/2024

​The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Rehabilitation.​​
​05/17/2023
​The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Rehabilitation.​
10/19/2022

The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Rehabilitation.​
​01/01/2022
​Inclusion of a policy in a Code Update memo does not imply that a full review of

the policy was completed at this time.

 

This policy has been identified for the CPT code update, effective 01/01/2022.


The following CPT codes have been added to the policy: 94625 and 94626.

​The following HCPCS code has been termed from the policy:​ G0424.


Revisions From 10.04.01l:
06/30/2021The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Rehabilitation.​
​06/17/2020
​This policy has been reissued in accordance with the Company's annual review process.
​12/30/2019
​The version of this policy will become effective 12/30/2019.

The intent of this policy remains unchanged; however, the policy has been updated to clarify current benefits regarding maintenance therapy.

Revisions From 10.04.01k:
06/06/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Pulmonary Rehabilitation.

Effective 10/05/2017 this policy has been updated to the new policy template format.
1/1/2022
12/31/2021
4/29/2026
10.04.01
Medical Policy Bulletin
Commercial
No
Connect with Us

2026 Independence Blue Cross

Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.