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Pulmonary rehabilitation billing guide: G0424 (2026)
Pulmonary rehabilitation is covered and clinically valuable, but three things gate payment: which code fits your program, the Medicare session limit, and the documentation behind the qualifying diagnosis. Get any of them wrong and reimbursement stops without warning. This guide walks through each.
Educational guide, not compliance advice. Pulmonary rehab codes, session limits, and coverage rules change and vary by setting — verify against current CMS guidance and your MAC's policy before billing.
Code selection: G0424 vs. 94625/94626
Comprehensive pulmonary rehabilitation — the structured, physician-supervised program benefit — is commonly reported with G0424. Separate outpatient pulmonary rehab services fall to their own code family, 94625 (without continuous oximetry) and 94626 (with continuous oximetry). The right choice depends on the program you actually run and the setting you run it in; billing the comprehensive-program code for services that aren't part of that benefit — or vice versa — is a predictable denial. Confirm the current descriptor and applicable code before billing.
Session limits
Medicare covers a defined number of pulmonary rehabilitation sessions, with an extension possible when medical necessity is documented. The practical problem is simple: someone has to count. Sessions billed past the covered limit without documentation to support an extension are written off, and the counter is easy to lose across a multi-week program. A biller handling pulmonary rehab should track the count against the current Medicare limit as a matter of routine.
Qualifying diagnosis and documentation
Coverage depends on a documented qualifying diagnosis — commonly moderate-to-severe COPD — along with an individualized treatment plan and the required physician involvement and supervision. If the qualifying diagnosis or the supervision requirement isn't clearly in the record, the claim fails no matter how good the program is. The documentation has to prove the coverage criteria, not just describe the visit.
The patient's share
Under Medicare Part B, pulmonary rehab typically leaves the patient responsible for a coinsurance amount. That's a benefits-verification and patient-communication point as much as a billing one: patients should hear their cost-share before the program starts, not discover it on a statement afterward.
Frequently asked questions
Is pulmonary rehab billed with G0424 or 94625/94626?
It depends on the program and setting. Comprehensive pulmonary rehabilitation is commonly reported with G0424, while separate outpatient pulmonary rehab services use 94625/94626. Confirm the correct code for your specific program against current CMS guidance.
How many pulmonary rehab sessions does Medicare cover?
Medicare covers a defined number of sessions, with an extension possible when medical necessity is documented. Because the exact numbers and conditions change, sessions should be tracked against the current Medicare policy rather than assumed.
What documentation supports a pulmonary rehab claim?
A qualifying diagnosis (such as moderate-to-severe COPD), an individualized treatment plan, the required physician involvement and supervision, and an accurate session count. Gaps in any of these are the common denial causes.