Medicare Coverage for Pulmonary Rehabilitation

Breathing isn’t something most people think about—until it becomes difficult. For many older adults living with chronic lung disease, everyday activities like walking, showering, or climbing stairs can leave them gasping for air. Pulmonary rehabilitation exists to change that.

And yes—Medicare does cover pulmonary rehabilitation for qualifying patients when it’s deemed medically necessary. This structured, evidence-based program can dramatically improve breathing, stamina, and overall quality of life.

Millions of Americans on Medicare live with chronic respiratory conditions. Chronic obstructive pulmonary disease (COPD) alone affects more than 16 million people in the U.S., and it’s one of the most common reasons older adults end up hospitalized. COVID-19 has also left thousands with lingering respiratory symptoms—especially those with preexisting pulmonary or cardiac risk.

In this article, we’ll break down everything Medicare beneficiaries need to know about pulmonary rehabilitation: what it includes, who qualifies, how many sessions are covered, and what to expect from a typical program. We’ll also explain costs, referrals, facility access, and how to get help if you run into roadblocks.

What is Pulmonary Rehabilitation?

Pulmonary rehabilitation is a structured, multidisciplinary program designed to support people with chronic lung disease. It's more than just exercise—it's a comprehensive approach to improving respiratory health and overall function.

The core components include:

• Physician-prescribed exercise: Customized aerobic and strength training to build endurance and reduce breathlessness.
• Education: Guidance on managing respiratory conditions, using inhalers correctly, and recognizing warning signs.
• Breathing techniques: Including diaphragmatic and pursed-lip breathing for better oxygen efficiency.
• Psychosocial support: Counseling to help manage anxiety, depression, or isolation—common among people with breathing issues.
• Nutritional guidance: Strategies for maintaining a healthy weight and optimizing respiratory function.

These programs are often led by a team that may include pulmonologists, respiratory therapists, nurses, physical therapists, dietitians, and social workers. The goal? Improved breathing, greater independence, and a better quality of life.

Who Qualifies for Medicare-Covered Pulmonary Rehabilitation?

To receive Medicare-covered pulmonary rehabilitation, patients must meet specific clinical criteria and follow referral requirements. Medicare’s guidelines are strict—but with the right documentation and medical diagnosis, many patients qualify.

Covered conditions include:

• Moderate to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease, or GOLD classification II–IV)
• COVID-19 with documented respiratory dysfunction that persists for at least four weeks after infection, as defined by CMS’s expanded coverage criteria effective January 1, 2022
• Other qualifying diagnoses listed in Medicare’s National Coverage Determination (NCD), often evaluated case-by-case

To qualify, your treating physician must provide a referral and confirm that pulmonary rehab is medically necessary. This involves a documented diagnosis, severity classification (especially for COPD), and clinical rationale for referral.

You may also need:

• Pulmonary function test results (e.g., FEV1, FVC)
• 6-minute walk test or oxygen saturation data
• Symptom documentation (dyspnea, fatigue, limitations with activities of daily living)

Accurate diagnosis and staging—especially with COPD—are key. GOLD classification determines disease severity, and Medicare uses this to authorize treatment. Your provider should reference billing and coding guidelines like A56152 and CMS Change Request 6823 to help smooth the approval process.

Medicare Coverage Details for Pulmonary Rehabilitation

Pulmonary rehabilitation falls under Medicare Part B, which covers outpatient medical services.

Here’s what Medicare covers:

• Up to 36 sessions over 36 weeks (typically 2 sessions per week)
• Each session can last up to one hour, and you may receive two sessions per day if medically indicated
• If your condition justifies it, Medicare may approve an additional 36 sessions (for a total of 72) with proper documentation

Covered settings include:

• Doctor’s offices
• Hospital outpatient departments

Telehealth options for pulmonary rehabilitation are covered by Medicare through September 30, 2025, for patients in any location. After that date, coverage will be limited to those in rural areas or specific medical settings unless the rules change.

Not all programs offer virtual rehab, and some Medicare Advantage plans may apply different coverage rules—so it’s worth confirming what’s available in your area.

Medicare’s claims processing manual and the coverage rules outlined in 42 CFR 410.47 detail program requirements, session limits, and the role of the medical director.

What to Expect in Medicare-Covered Pulmonary Rehabilitation Programs

Once you're approved, you’ll begin with a baseline assessment to evaluate your current health and build a tailored treatment plan. This typically includes:

• 6-minute walk test (to assess endurance)
• Pulmonary function tests
• Possibly an exercise stress test (to rule out cardiac limitations)

During your program, you’ll participate in:

• Supervised exercise sessions that include aerobic exercise, conditioning, breathing retraining, and strengthening, as required under Medicare’s program guidelines
• Breathing technique training, such as pursed-lip and diaphragmatic breathing
• Education modules on medication use, symptom monitoring, and flare-up prevention
• Energy conservation strategies for daily activities
• Emotional and peer support, which is vital to long-term behavior change

Programs typically last several weeks, with sessions two to three times a week. Providers track your progress and adjust the plan as needed. Many programs offer a “graduation” visit and recommend a maintenance phase—though Medicare does not always cover maintenance without documentation of new medical need.

Costs and Out-of-Pocket Expenses for Pulmonary Rehabilitation

Even though Medicare Part B covers pulmonary rehab, patients are still responsible for some out-of-pocket costs.

Here’s the cost structure under Original Medicare in 2025:

• Annual Part B deductible: $257 (as of 2025)
• 20% coinsurance: You pay 20% of the Medicare-approved amount per session
• Outpatient facility copayment: If receiving rehab at a hospital outpatient department, you may owe an additional copay per session

You can reduce your costs in several ways:

• **Medigap (Medicare Supplement) plans**: These help cover your 20% coinsurance
• Medicare Advantage (Part C) plans: May have different cost-sharing structures—check your plan for copay and network rules
• Financial assistance programs: Some hospitals offer income-based support or charity care for eligible patients

Cost also depends on where you receive care. Hospital outpatient departments may charge more than a doctor’s office or independent facility, so ask about fees upfront.

Finding Medicare-Approved Pulmonary Rehabilitation Facilities

To access pulmonary rehab, you’ll need a provider that accepts Medicare assignment—meaning they agree to Medicare’s payment terms.

How to find approved facilities:

• Ask your doctor or pulmonologist for a referral
• Use the Medicare.gov Care Compare tool
• Call the American Lung Association Helpline for facility recommendations
• Contact your Medicare Administrative Contractor (MAC) for local options

Questions to ask potential providers:

• What credentials do your staff have?
• How is the program structured?
• What accommodations or equipment are available?
• What’s your success rate or patient improvement data?

If you live in a rural area, you may qualify for telehealth-based rehabilitation or mobile services. Some hospitals also offer transportation support or home-based care transitions after graduation.

How to Get Started with Pulmonary Rehabilitation

If you think you qualify for Medicare pulmonary rehabilitation coverage, here’s how to begin:

1. Talk to your doctor about your symptoms and medical history
2. Confirm your diagnosis and staging, especially for COPD (using GOLD classification II–IV)
3. Get a referral for pulmonary rehabilitation from your treating physician
4. Find a Medicare-approved provider that offers a program near you (or via telehealth)
5. Schedule your initial assessment and submit required documentation
6. Begin attending sessions regularly and follow your treatment plan

You’ll want to bring:

• Recent test results
• List of medications
• Your Medicare card
• Any supplemental insurance documentation

Ask your doctor: “Will this program meet Medicare’s documentation requirements?” and “Do you know facilities that accept Medicare assignment?”

Common Challenges and How to Overcome Them

Some patients face hurdles when trying to start or stay in a rehab program.

Common barriers include:

• Coverage denial due to missing documentation or unclear diagnosis
• Transportation issues, especially in rural areas
• Scheduling conflicts or missed sessions due to illness
• Uncertainty about program expectations

If Medicare denies coverage, you have the right to appeal. Your doctor or a Solace advocate can help gather additional documentation and submit a formal request for reconsideration.

If travel is difficult, look into transportation support from local services or caregiver networks—and ask whether telehealth is an option. You can also ask about home-based maintenance programs to continue progress once your sessions end.

How a Solace Advocate Can Help Navigate Pulmonary Rehabilitation

Medicare paperwork. Specialist referrals. Denial letters. These are real hurdles—and you don’t have to face them alone.

Solace chronic illness advocates are healthcare professionals who specialize in guiding patients through complex systems like Medicare.

They can help by:

• Identifying whether you meet the medical necessity criteria
• Gathering and organizing the required documentation
• Finding Medicare-approved providers and scheduling appointments
• Crafting insurance appeals if your application is denied
• Coordinating between your doctor, pulmonologist, and rehab provider
• Preparing you for what to expect—and how to stay on track

Thousands of patients have leaned on Solace advocates to get the care they need. You can, too. Schedule an appointment today.

Final Thoughts

Pulmonary rehabilitation can be life-changing—and Medicare pulmonary rehabilitation coverage makes it accessible to those who qualify. With the right support, documentation, and follow-through, this program can help you breathe easier, live more fully, and regain control.

If you think you or a loved one might benefit, now is the time to act. Talk to your doctor. Ask about referrals. And if you hit any roadblocks, don’t hesitate to reach out to a Solace advocate who can guide you every step of the way.

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FAQ: Frequently Asked Questions About Medicare Coverage for Pulmonary Rehabilitation

How long does Medicare approval take for pulmonary rehabilitation?

Approval time varies depending on your provider and how complete your paperwork is. If your physician includes all necessary documentation requirements, including diagnosis codes and test results, approval can take as little as a few days. Some Medicare Administrative Contractors process faster than others, so ask your doctor to follow CMS billing protocols, including references to billing and coding: pulmonary rehabilitation services (A56152) and CMS Change Request 6823.

Can I switch facilities during my rehabilitation program?

Yes. If you move or need a different facility, you can switch as long as the new program is a Medicare-approved doctor or facility that meets physician standards and program requirements under 42 CFR 410.49. Your new provider will likely need updated paperwork and coordination with your previous team.

What happens if I miss sessions due to illness?

Missed sessions can usually be made up, but Medicare tracks attendance closely. If you go too long without participating, your physician may need to re-certify the need for continued treatment. Consistency is also important for progress, especially in structured plans involving aerobic exercise and conditioning.

Will Medicare cover maintenance programs after completing rehabilitation?

Medicare typically does not cover maintenance programs unless there's documented evidence of a worsening condition. However, some coverage provisions allow for continued services if a new exacerbation or medicare-approved diagnosis is confirmed. Maintenance plans are sometimes recommended by a program’s medical director, but must be justified under National Coverage Determination (NCD) criteria.

How often can I receive pulmonary rehabilitation under Medicare?

Medicare covers up to 36 pulmonary rehabilitation sessions per year, usually over 36 weeks, with up to two sessions per day. If medically justified, an additional 36 sessions can be authorized. The session limitations must be respected unless the medical need is clearly documented and approved by Medicare or your Medicare Advantage plan.

Does Medicare cover transportation to rehabilitation sessions?

Original Medicare does not cover transportation unless it's an emergency. Some Medicare Advantage Plans offer transportation benefits, especially in rural or underserved areas. Community agencies or your Medicare Administrative Contractor may also help identify local transportation resources.

Can I receive pulmonary rehabilitation at home?

Yes—temporarily. Telehealth options are covered through September 30, 2025, and can include virtual assessments and supervised sessions, depending on the provider’s capabilities. To qualify, the provider must be in-network, and your participation must still meet the core requirements for outcomes assessment, safety, and oversight by a medical director.

What other treatments does Medicare cover for chronic lung conditions?

Medicare covers a range of services, including:

• Oxygen therapy for qualifying patients with low blood oxygen levels
• Bronchodilators and inhaled steroids (usually covered under Part D)
• Pulmonary function tests
• Smoking cessation programs, including counseling and support
• Nicotine patches under certain Part D plans

Pulmonary rehab often works best in combination with these treatments.

How do I find a facility that accepts Medicare?

You can search Medicare.gov or contact the American Lung Association Helpline for assistance. Look for facilities that clearly state they accept Medicare assignment and meet federal requirements under 42 CFR 410.49. Make sure the provider employs in-network healthcare professionals and offers an individualized treatment plan based on your test results and functional goals.

What’s the difference between psychological counseling and peer support in these programs?

Psychological counseling is typically provided by licensed mental health professionals and focuses on anxiety, depression, or adjustment issues related to chronic illness. Peer support, on the other hand, involves group sessions or social support from others undergoing rehab. Medicare may cover both when included as part of a medically necessary and structured pulmonary rehabilitation program, especially if tied to a psychosocial assessment.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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