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LIST OF MODIFIERS

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...

Coding guidelines for Supervised Exercise Therapy (SET)


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.

SET program covers Up to 36 sessions over a 12-week period if all of the following components of a SET program are met: 

The SET program must:

Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication.

Be conducted in a hospital outpatient setting, or a physician’s office.

Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD.

Be under the direct supervision of a physician, physician assistant, or nurse practitioner/clinical nurse specialist who must be trained in both basic and advanced life support techniques.

Coding Requirements for SET

CPT: 

93668 Peripheral arterial disease (PAD) rehabilitation, per session

ICD 10 Codes:

I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg 
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg 
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs 
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity 
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg 
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg 
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs 
I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity 
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg 
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg 
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs 
I70.618 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, other extremity 
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg 
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg 
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs 
I70.718 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, other extremity 

Place of Service (POS):

11 Office
19 Off Campus-Outpatient Hospital
22 On Campus-Outpatient Hospital

MACs will deny claims for SET if services are not provided in above POS.

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