Does G0237 require prior authorization?

No, G0237 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0237?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0237`, Therapeutic procedures to increase strength or endurance of respiratory

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A physician order must prescribe exercise including aerobic exercise combined with other appropriate exercise types and must indicate exercise is to be provided at each treatment session.
An individualized plan of care must be initially established by the physician and reviewed and signed by the physician every 30 days documenting how components are utilized for each patient.

Documentation must record that a physician is immediately available and accessible for medical consultations and emergencies whenever program services are furnished, and supervising physicians must have documented expertise in respiratory pathophysiology, BLS or ACLS training, and state medical licensure.

Key Coverage Criteria

Individual pulmonary rehabilitation components are covered when tailored to the individual patient based on a thorough evaluation, require a qualified clinician due to complexity, and are medically reasonable and necessary for treatment of an acute or exacerbated pulmonary condition.
Medicare covers Pulmonary Rehabilitation Program services for patients with moderate to very severe COPD (GOLD II-IV) when referred by the physician treating the chronic respiratory disease and when all program requirements are met.
Medicare covers pulmonary rehabilitation program services for confirmed or suspected COVID-19 patients who experience persistent respiratory symptoms for at least four weeks (effective Jan 1, 2022) when all program requirements are met.
Pulmonary rehabilitation program services are covered when the program provides a comprehensive, evidence-based multidisciplinary intervention for chronic respiratory impairment and fulfills applicable CMS manual and NCD 240.8 requirements.
Therapeutic procedures whose principal aim is to treat a respiratory impairment must be billed using HCPCS codes G0237, G0238, or G0239.
Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.

13 Active Policies

NORIDIAN-JE-L34149, Respiratory Care

NORIDIAN-JF-L34149, Respiratory Care

A56717, Billing and Coding: Respiratory Therapy (Respiratory Care)

A57224, Billing and Coding: Respiratory Care

AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices

AETNA-CPB-0369, Myalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF)

ANTHEM-CG-REHAB-03, Pulmonary Rehabilitation

BCBSIL-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSMT-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSNM-THE803.025, Outpatient Pulmonary Rehabilitation

BCBSOK-THE803.025, Outpatient Pulmonary Rehabilitation

AETNA-CPB-0004, Obstructive Sleep Apnea in Adults

A56152, Billing and Coding: Pulmonary Rehabilitation Services

`G0237`, Therapeutic procedures to increase strength or endurance of respiratory

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

G0237, Therapeutic procedures to increase strength or endurance of respiratory

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`G0237`, Therapeutic procedures to increase strength or endurance of respiratory