Medicare Coverage Determinations | Aetna Medicare (2024)

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This is effective for services on or after May 25, 2017.

The Centers for Medicare and Medicaid Services (CMS) issued an NCD to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD.

SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest.
SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with 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:

  1. Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication
  2. Be conducted in a hospital outpatient setting, or a physician’s office
  3. Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD
  4. Be under the direct supervision of a physician (as defined in Section 1861(r)(1)) of the Social Security Act (the Act), physician assistant, or nurse practitioner/clinical nurse specialist (as identified in Section 1861(aa)(5) of the Act)) who must be trained in both basic and advanced life support techniques.
  5. This summarizes CMS transmittal 207 (replacing 204, 205 and 206).

Medicare Coverage Determinations | Aetna Medicare (1) Medicare Coverage Determinations | Aetna Medicare (2)

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Y0001_4006_10829Approved 10/27/2017
Page last updated: Wed Jul 14 16:51:22 UTC 2021

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