2013 Payment for Hospital Outpatient Pulmonary Rehabilitation Programs Announced

August 16, 2012

The proposed payment rate for calendar year (CY) 2013 for outpatient pulmonary rehabilitation (PR) programs (G0424) was announced in the Federal Register on July 30 by the Centers for Medicare and Medicaid Services as part of its annual update to payment rates for hospital outpatient services under the prospective payment system.

As it stands now, the PR rate will be $39.58 per session beginning January 1, 2013, a slight increase over this year’s rate of $37.00. By comparison, the proposed CY 2013 payment rate for respiratory codes G0237, G0238 and G0239 (used for non-COPD patients) is $35.12. Keep in mind, however, that two of these codes (G0237 and G0238) are billed in 15 minute increments.

As discussed recently, AARC and its sister pulmonary societies have come to the conclusion that the recent decrease in payment from the 2010 and 2011 rates is not due to some fault of CMS and its data analysis. Rather, it is due to hospitals underreporting to CMS the charges associated with the PR services they provide. Simply put, the hospitals are not accounting for all of the services that used to be billed separately but are now part of the all-inclusive single G code.

An on-going effort by respiratory therapists who work in PR programs to educate their hospital’s billing staff on what it takes to accurately calculate the appropriate charges for G0424 is the only why we can ensure that CMS has correct data upon which to calculate the payment rates in the future. This will be a long-term process, but it is a necessary one to ensure that we protect and preserve these valuable programs.

Review the Pulmonary Rehabilitation Program Toolkit for more information on how respiratory therapists can make a difference for their patients in the goal to increase future PR payment rates. Take action now, it’s never too late!