What Medicare covers for pulmonary rehab delivered by video

Medicare does reimburse telehealth pulmonary rehabilitation, but only under specific conditions. Your doctor must refer you for a medically necessary program, and the pulmonary rehab provider must be enrolled in Medicare and meet federal requirements for telehealth delivery. Medicare Part B covers the sessions at the same rate as in-person visits — typically 80% of the approved amount after you meet your deductible, with you responsible for the remaining 20%.

The key difference from in-person rehab is that not all pulmonary rehab programs offer telehealth, and Medicare's rules about which sessions can happen by video have changed over time. As of 2024, Medicare allows the full course of pulmonary rehab to be delivered remotely if the provider is set up to do so, though some programs still mix in-person and telehealth visits. You will need to confirm with your specific provider whether they offer telehealth and whether Medicare will cover it at your location.

Key Takeaways

  • Medicare Part B covers telehealth pulmonary rehab at the same 80/20 split as in-person visits, provided your doctor refers you and the provider is Medicare-enrolled.
  • Your pulmonary rehab provider must be set up to deliver sessions by video and must meet Medicare's standards for remote patient monitoring and supervision.
  • A standard course is 36 sessions over 12 weeks, though your doctor may prescribe more or fewer depending on your condition.
  • You should confirm with your provider before starting whether they accept Medicare telehealth and what your out-of-pocket cost will be.

How Medicare determines what it will pay

Medicare reimburses pulmonary rehab based on the Current Procedural Terminology (CPT) codes the provider submits. The most common codes are 93002 (initial evaluation) and 93003 (each subsequent session). The amount Medicare pays varies by your location — it is based on the Medicare Physician Fee Schedule for your region — but the structure is the same everywhere: Medicare pays 80% of the approved amount, and you pay 20%.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20% coinsurance. Medicare Advantage plans have their own rules — some cover pulmonary rehab fully, others charge a copay per session, and some require prior authorization. You should contact your plan directly before your first telehealth session to confirm what you will owe.

The provider's location matters for reimbursement rates, not yours. If you live in a rural area but your provider is in a city, Medicare pays the city rate. This is one reason telehealth can be valuable — you may reach a provider in a higher-reimbursement area without traveling.

What your doctor's referral must include

Your doctor does not straightforward write "pulmonary rehab" and send it to any program. The referral must state that pulmonary rehab is medically necessary for your condition. Medicare covers it for people with chronic obstructive pulmonary disease (COPD), post-COVID respiratory impairment, pulmonary fibrosis, asthma, bronchiectasis, and other chronic lung conditions. Your doctor must document that you have a diagnosis that meets Medicare's criteria and that rehab will help you improve or maintain function.

The referral should also specify whether the program can be delivered by telehealth or whether you need in-person sessions. Some doctors assume in-person only, so if telehealth is important to you — because of distance, mobility, or scheduling — mention it to your doctor before they send the referral. The pulmonary rehab program will contact your doctor if they need more information before accepting you.

How telehealth pulmonary rehab sessions work

A typical telehealth pulmonary rehab session lasts 30 to 60 minutes and includes exercise instruction, breathing techniques, and education about managing your lung condition. You will need a quiet space at home, a device with a camera and microphone (computer, tablet, or smartphone), and a stable internet connection. The therapist will watch you perform exercises, correct your form, and monitor your breathing and heart rate response.

You may be asked to use a pulse oximeter — a small device that clips to your finger and measures oxygen levels — so the therapist can see how your body is responding. Some programs send you a pulse oximeter or blood pressure cuff before you start. The therapist will tell you what equipment you need and how to set up your space so they can see you safely.

Sessions are usually scheduled twice a week for 12 weeks, though your doctor may prescribe a different schedule. If you miss a session, the program will reschedule you. Medicare requires that a licensed respiratory therapist or physical therapist supervise the sessions, even though you are at home.

When Medicare will not cover telehealth pulmonary rehab

Medicare will not pay if your doctor's referral does not document a covered diagnosis or if the program is not Medicare-enrolled. It will also not pay if you have not met your Part B deductible for the year — you will owe the full cost of early sessions until the deductible is satisfied. After that, you pay 20% coinsurance per session.

Some Medicare Advantage plans require prior authorization before you start. If you begin telehealth rehab without authorization and your plan denies it later, you could be responsible for the full bill. Always check with your plan before your first session.

Medicare does not cover pulmonary rehab if it is delivered by a provider who is not enrolled in Medicare, even if the provider is licensed and may have access to. Ask the program directly whether they accept Medicare before you commit to starting.

How to find a Medicare-enrolled telehealth pulmonary rehab program

Start by asking your primary care doctor or pulmonologist for a referral. They often know which programs in your area or region offer telehealth. If your doctor does not have a recommendation, you can search the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) on the Centers for Medicare & Medicaid Services website to verify that a program is enrolled, though this database does not tell you whether they offer telehealth.

Hospitals and large health systems often have pulmonary rehab programs that offer telehealth. Smaller independent programs may not. When you contact a program, ask directly: "Do you accept Medicare?" "Do you offer telehealth?" and "What is my out-of-pocket cost per session?" Write down the answers so you have them in writing.

If you cannot find a program near you or one that offers telehealth, ask your doctor whether they can refer you to a program in another state. Medicare covers telehealth pulmonary rehab regardless of where the provider is located, as long as they are Medicare-enrolled and you are in a state where they are licensed to practice.

What to ask your doctor and your insurance plan

Before your first telehealth session, ask your doctor: "Is pulmonary rehab medically necessary for my condition?" "Can the program be delivered by telehealth?" and "How many sessions are you prescribing?" Write down the answers and keep them with your insurance documents.

Contact your Medicare plan (or your Medigap or Medicare Advantage plan if you have one) and ask: "Will you cover telehealth pulmonary rehab?" "Do I need prior authorization?" "What is my out-of-pocket cost per session?" and "What should I do if a claim is denied?" Ask them to send you the answer in writing or note the date, time, and representative's name if you speak by phone.

When you contact the pulmonary rehab program, ask: "Are you Medicare-enrolled?" "Do you offer telehealth?" "What equipment do I need at home?" "What is the schedule?" and "What happens if I need to reschedule a session?" Programs that take Medicare seriously will answer these questions clearly.

Frequently Asked Questions

Can I do telehealth pulmonary rehab if I live in a state different from the provider?

Yes, as long as the provider is licensed in your state or holds a multistate license. Medicare does not restrict telehealth pulmonary rehab by state, but individual providers may. Ask the program whether they can treat patients in your state before you start.

What if my Medicare Advantage plan denies the telehealth pulmonary rehab claim?

Contact your plan's appeals department when ready and ask for the reason for denial. If the program is Medicare-enrolled and your doctor's referral is valid, the plan may have made an error. You can also ask your doctor's office to appeal on your behalf. Keep all paperwork from the program and your plan.

Do I have to do all 36 sessions, or can I stop early?

Your doctor prescribes the number of sessions, and Medicare will only pay for what is prescribed. If you want to stop early, talk to your doctor and the program. If you need more sessions, your doctor can write a new referral. You are not locked in, but changes require your doctor's approval.

Will telehealth pulmonary rehab work as well as in-person?

Research shows that telehealth pulmonary rehab produces similar improvements in exercise capacity and breathing function as in-person rehab for most people. The key is that you do the exercises and follow the therapist's guidance. If you have severe mobility issues or cannot set up a safe space at home, in-person may be better — discuss this with your doctor.

What if I do not have a regular doctor to refer me?

You will need a doctor's referral to start pulmonary rehab, and Medicare will not pay without one. If you do not have a primary care doctor, contact a local federally may have access to health center or urgent care clinic and ask for a referral. Many will see you for an initial visit and provide the referral if pulmonary rehab is appropriate for your condition.