Make Your Voice Heard – CMS Reducing Respiratory Therapy Reimbursement in 2017

Respiratory therapy works for ALL respiratory diseases. The research, science and years of studies have confirmed this statement of fact. However, in a period where official diagnosis and cases of Asthma, Allergies, and Chronic Obstructive Pulmonary Disease (COPD) are RISING, the Centers for Medicare and Medicaid Services (CMS) recently announced a reduction in the amounts they will allocate for pulmonary rehabilitation starting in 2017.

Respiratory Therapist and Right2Breathe Director of Education Michele DaSilva speaks with a recently diagnosed COPD patient about some of the benefits of pulmonary rehab at the recently completed Right2Breathe FREE COPD Screening event in Bakersfield, California.

It is not news that too many COPD patients struggle to gain access to the few programs currently available. Due to an already too low reimbursement, along with the restriction on the total amount of pulmonary rehabilitation visits they are permitted during their lifetime, there simply are not enough programs to meet the demand from our community. Many programs struggle to remain in operation because of the low reimbursement from CMS. Moreover, the low rate discourages development of new programs in areas where access is non-existent.

The CMS announced final rules that update payments to hospitals under the Hospital Outpatient Prospective Payment System beginning Jan. 1, 2017 (CY 2017). These rules include payment for Pulmonary Rehabilitation. The problem however is that although it’s assumed that these reductions are designed to save costs; the reality exists that these reductions in reimbursement will restrict patients covered by Medicare and Medicaid to receive quality pulmonary rehabilitation for all respiratory conditions.

COPD patient and double-lung transplant recipient Mel Bryson is living proof that pulmonary rehabilitation works.
COPD patient and double-lung transplant recipient Mel Bryson is living proof that pulmonary rehabilitation works.

Fortunately the payment rates are not final, yet. Those impacted with respiratory illness, disease or afflictions ranging from currently diagnosed patients, to caregivers and friends and family of people who depend on pulmonary rehabilitation have until December 31st, 2016 to do something about this proposed change. The voice of those actually living with diseases is incredibly impactful to government lead programs such as the CMS.

The Right2Breathe Project, in conjunction with the US COPD Coalition are asking all who have benefitted or currently depend on the hard work of pulmonary professionals to take a few moments to submit your support of this industry and displeasure in the CMS’s reduction in reimbursement for the following Ambulatory Payment Classification group to which these codes were to be assigned has also changed.

  • G0237 — Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
  • G0238 — Therapeutic procedures to improve respiratory function, other than described by G0237, one on one, face to face, per 15 minutes (includes monitoring)
  • G0239 — Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
  • G0424 — Pulmonary Rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day

This is an exceptional opportunity for us to make a difference, and help CMS recognize that pulmonary rehabilitation will save money in the short and long term, but more importantly that it provides COPD patients and those living with other respiratory diseases with access to the only scientifically proven, non-pharmacological clinical intervention.

Now, here’s how to submit your comment.

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Submit your comments electronically at by hitting the “comment now” button above. By clicking that button, you’ll be directed to the CMS feedback page. We invite you to express your concern about their decision, and how pulmonary rehabilitation helps you or those you love live a higher quality of life.

Remember – Everybody Has A Right2Breathe – and the Right to effective healthcare.