CommercialAdministrativeLow impact
10.04.01m, Pulmonary Rehabilitation
Independence Blue Cross·PA · Pulmonology, Physical Therapy, PM&R (Physical Medicine & Rehab)·Medical Policy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued pulmonary rehabilitation policy 10.04.01m on 04/29/2026 to reaffirm coverage criteria and program requirements. No substantive coverage changes were made; this is a routine reissuance confirming the company's continuing position. The policy covers outpatient pulmonary rehabilitation for patients with moderate to moderately severe respiratory impairment meeting specific clinical criteria, and excludes home-based programs as experimental.
Action Required
No immediate action required. This is a policy reissuance with no substantive changes to coverage, billing codes, or medical necessity criteria. Billing team should note that CPT codes 94625 and 94626 (added effective 01/01/2022) and HCPCS code S9473 remain the applicable codes for pulmonary rehabilitation billing. Verify that your billing system reflects these codes and the documented coverage criteria (moderate to moderately severe respiratory impairment, continued symptoms despite optimal medical management, reduced exercise tolerance). No workflow changes are necessary at this time.