ARM 37.86.3105. OUTPATIENT HOSPITAL SERVICES, PULMONARY REHABILITATION SERVICES

(1) Pulmonary rehabilitation services are limited to the following: (a) a maximum of 36 hours over a period not less than two weeks and not more than six weeks, limited to one of the following diagnoses: (i) persistent asthma; (ii) emphysema; (iii) chronic bronchitis; (iv) bronchiectasis; (v) interstitial lung disease; and (vi) chronic airway obstruction. (2) If applicable, the patient must have ceased smoking or be in a smoking cessation class. (3) The following pulmonary rehabilitation services are not covered: (a) education, treatment, and therapies that are not individualized to a specific patient need or are not an integral part of the treatment session; (b) routine psychological screening and treatment where intervention is not indicated; (c) films/videos; (d) duplicate services; (e) maintenance care when there is no expectation of further improvement; (f) treatment that is not medically necessary because the patient requires a general strengthening and endurance program only; and (g) treatment that is not medically necessary because the patient is at an early stage of pulmonary disease as demonstrated by a lack of significant findings in diagnostic testing.