Pulmonary rehabilitation (PR) is a multidisciplinary approach to reducing symptoms and improving quality of life (QOL) in individuals with compromised lung function. Outpatient PR programs generally include a patient assessment followed by therapeutic interventions including exercise training, education, and behavior change.
Comprehensive outpatient PR programs may include: team assessment, individual training, psychosocial intervention, exercise training, and follow-up. Individuals should have the ability to perform the exercise training and have a high level of motivation to participate in and complete the program.
Individuals for PR should be medically stable and not limited by another serious or unstable medical condition. Contraindications to PR include but are not limited to:
The focus of therapy is to educate the individual and establish a program of adaptive changes to a chronic medical illness. The optimal outcome is achieved when the patient continues these adaptive changes on an independent basis after discharge from the program.
A single course of PR in the outpatient ambulatory care setting may be considered medically necessary for ANY of the following indications:
Outpatient PR for any other indication not listed above is considered not medically necessary.
|Classification of Severity of Airflow Limitation in COPD a,b|
|GOLD 1||Mild||FEV1 ≥ 80% predicted|
|GOLD 2||Moderate||50% ≤ FEV1 < 80% predicted|
|GOLD 3||Severe||30% ≤ FEV1 < 50% predicted|
|GOLD 4||Very Severe||FEV1 < 30% predicted|
|a Based on post-bronchodilator FEV1|
|b In patients with FEV1/FVC < 0.70|
The following indications for PR courses or programs are considered not medically necessary:
Comprehensive outpatient PR programs may include: team assessment, individual training, psychosocial intervention, exercise training, and follow-up. PR program length may be considered medically necessary for up to 18 sessions, depending on program and may include the following:
Note: Exercise conditioning is an essential component of pulmonary rehabilitation. Education in disease management techniques without exercise conditioning does not improve health outcomes of individuals who have chronic obstructive pulmonary disease.