Supervised Exercise to Be Covered by Medicare as Treatment for Artery Disease

Patients with peripheral artery disease (PAD) can now have supervised exercise therapy covered by Medicare, according to a recent announcement by CMS.

The decision memo published by CMS describes the evidence supporting supervised exercise therapy for those with PAD, a vascular disorder experienced by 12% of Americans that causes narrowing in the arteries of the lower extremities. The most common symptom is intermittent claudication, which is leg pain or discomfort that appears during walking or exercising.

Although exercising may trigger the symptoms of intermittent claudication, supervised exercise therapy is the initial line of treatment for PAD recommended by the American College of Cardiology Foundation and the American Heart Association (AHA). It involves short periods of walking on a treadmill alternated with periods of rest when symptoms arise, performed under the supervision of a trained exercise therapist. However, in recent years, endovascular revascularization has become a more popular option as it results in immediate relief, but the foundation guidelines still recommend it be reserved for the most severe cases.

In response to a request from the AHA to review coverage policies for supervised exercise therapy in PAD, CMS conducted a thorough literature review of its effectiveness. Prior studies have found that such therapy can indeed increase walking distance and reduce pain while being safe and tolerable. All but 2 of the 182 public comments received by CMS from professional societies, physicians, physiologists, and other healthcare professionals supported covering supervised exercise therapy for Medicare beneficiaries with PAD.

“The evidence is sufficient to conclude that supervised exercise therapy improves health outcomes for Medicare beneficiaries with intermittent claudication due to PAD,” the CMS memo stated, adding that they “encourage all providers to adopt and adhere to evidence-based care for patients with PAD.”

Medicare will now cover up to 36 sessions in a 12-week period if the exercise regimen meets certain criteria: session duration of 30 to 60 minutes; conducted in physician’s office or hospital outpatient setting; delivered by personnel trained in exercise therapy for PAD; and under the direct supervision of a physician or nurse practitioner. Patients must first visit the provider who diagnosed them with PAD in order to receive a referral for supervised exercise therapy, where they must also be offered education and counseling about cardiovascular disease and reducing risk factors for PAD.

The AHA praised CMS’ coverage decision in a press statement, with CEO Nancy Brown saying that the group was “so pleased” that PAD patients could now receive supervised exercise therapy through Medicare. The group, which has been a staunch advocate of supervised exercise as a first-line therapy for PAD, “couldn’t be more thrilled with today’s decision that will give more Americans the access they need to this important treatment option,” according to the statement.