Office Based Peripheral Artery Disease Evaluation and Supervised Exercise Therapy Covered by Medicare (Michigan/Ohio Model)

Purpose: Supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) is now a Medicare-covered benefit.

Materials and Methods: Key points in the 2014 clinical evidence update included (1) management of intermittent claudication (IC) exercise program; (2) supervised exercise is associated with increases in maximal walking distance compared with home-based or other unsupervised exercise programs; (3) supervised exercise is associated with greater increases in walking distance in people with aortoiliac disease than either stenting or optimum medical care; and (4) supervised exercise appears to be more cost effective than either angioplasty alone or supervised exercise plus angioplasty in people with IC caused by femoropopliteal occlusion.

Results: The Centers for Medicare & Medicaid Services has determined that the evidence is sufficient to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions over a 12-week period are covered if all of the following components of a SET program are met: the SET program must be (1) conducted in a hospital outpatient setting or a physician’s office, and (2) under the direct supervision of a physician (as defined in 1861(r)(1)), physician assistant, or nurse practitioner or clinical nurse specialist (as identified in 1861(aa)(5)), who must be trained in both basic and advanced life support techniques.

Conclusions: PAD affects 12% to 20% of Americans age 60 years and older, and the incidence of PAD increases considerably with age. SET has been demonstrated to be an effective therapy to lessen the symptoms of claudication and improve walking distance in patients with PAD in numerous trials. Stakeholders such as the American Heart Association have long recommended SET as a first-line, noninvasive, low-risk therapy for individuals with PAD with claudication. Despite the disease burden and the substantial evidence supporting SET as a safe and effective treatment for PAD, it is currently covered by Medicare.