edicare will now cover supervised exercise
therapy for a vascular condition that affects
about 8.5 million Americans, according to a
decision issued in June by the Centers for
Medicare and Medicaid Services.
The long-awaited decision means other insurers will likely
Medicare will cover the therapy for patients experiencing
symptoms of peripheral artery disease, or PAD, which
is caused by a buildup of plaque in the blood vessels. It
most commonly occurs in the legs, causing cramping and
pain. PAD patients have a much higher risk of heart attack
or stroke, and if left untreated, the disease can lead to
gangrene and amputation.
Under the new policy, beneficiaries will be required to
visit a doctor to receive a referral for supervised exercise
therapy, as well as receive information about reducing risk
factors, which may include education, counseling and
Then, Medicare will cover up to 36 sessions of 30 to 60
minutes each over a 12-week period, with the possibility of
approval for an additional 36 sessions over time.
CMS’ ruling was triggered by a formal
request last fall from the American Heart
Association, and the benefit was designed
using guidelines created by the AHA and the
American College of Cardiology.
“Supervised exercise training is a safe
and effective means to substantially improve
walking distance,” said Mark Creager, M.D.,
director of the Heart and Vascular Center
at Dartmouth-Hitchcock Medical Center in
Lebanon, New Hampshire.
“Hopefully this will open up more
opportunities for more patients with PAD
to get this treatment,” said Creager, a
former AHA president who focused on PAD
awareness and treatment during his tenure.
In advocating for the change from CMS,
the late Alan T. Hirsch, M.D., of the University
of Minnesota Medical School, said earlier this
year that it would dramatically improve the
quality of life for PAD patients.
Hirsch, a longtime AHA volunteer and pioneer in the field of
vascular medicine who died last month, had said supervised
exercise therapy is “the most clinically effective, safe and cost-effective” way to improve the painful cramps caused by artery
obstruction and triggered by walking and exercise.
AHA Chief Executive Officer Nancy Brown said the
exercise therapy is a “first-line, non-invasive” way to enhance
clinical outcomes and improve the quality of life for PAD
patients. About 12 percent to 20 percent of Americans age
60 and older have PAD.
“The Association has advocated for it since our first PAD
guidelines were issued in 2005,” Brown said in a statement.
“We couldn’t be more thrilled with [the] decision that will
give more Americans the access they need to this important
A 2015 paper published in Journal of the American
College of Cardiology showed supervised workouts worked
just as well as more costly stents in helping patients improve
the ability to walk.
Medicare covered the program of graduated exercise with
the help of a specialist for some kinds of heart events, but
until now it had not been covered for PAD.
Simple PAD treatment to
be covered by Medicare
By American Heart Association News