A single course of pulmonary rehabilitation in the outpatient ambulatory care setting may be considered medically necessary for the treatment of chronic pulmonary disease for individuals with moderate-to-severe disease who are experiencing disabling symptoms and significantly diminished quality of life despite optimal medical management.
A single course of pulmonary rehabilitation may be considered medically necessary in an outpatient ambulatory care setting as a preoperative conditioning component for those considered appropriate candidates for lung volume reduction surgery (see evidence review 7.01.71) or for lung transplantation (see evidence review 7.03.07).
Pulmonary rehabilitation programs are considered medically necessary following lung transplantation.
Pulmonary rehabilitation programs are considered investigational following other types of lung surgery, including but not limited to lung volume reduction surgery and surgical resection of lung cancer.
Multiple courses of pulmonary rehabilitation are considered investigational, either as maintenance therapy in individuals who initially respond, or in individuals who fail to respond, or whose response to an initial rehabilitation program has diminished over time.
Home-based pulmonary rehabilitation programs are considered investigational.
Pulmonary rehabilitation programs are considered investigational in all other situations.
