Billing and Coding: Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Supervised Exercise Therapy for the Treatment of Peripheral Arterial Disease with Symptomatic Lower Extremity Intermittent Claudication. After the initial 36 treatment sessions or 12 weeks (whichever comes first) beneficiaries may be eligible for another 36 treatment sessions with another referral from a physician. The requirements of this second referral are the same as for the initial referral. All claims submitted for additional sessions after the first 36 sessions or the initial 12 week period must append modifier -KX to the CPT code for this service in order to attest that those requirements have been fulfilled. ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary. Any diagnosis submitted must have documentation in the patient’s record to support coverage and medical necessity. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim. Claims submitted without such evidence will be denied as not medically necessary. Any diagnosis submitted must have documentation in the patient’s record to support coverage and medical necessity. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.