Transportation to cardiac rehab and pulmonary rehab: a 36-session ride plan, oxygen, and riders after bypass

What a rehab course means in rides

Cardiac rehab and pulmonary rehab are supervised exercise and education programs, and Medicare pays for the program but not the ride to it. A standard Medicare course is a maximum of 36 sessions of an hour each, no more than two per day, finished within 36 weeks (42 CFR 410.49 and 42 CFR 410.47). The Medicare contractor can approve 36 more. MedlinePlus says most cardiac programs last 3 to 6 months, and NHLBI describes pulmonary rehab as usually two or three sessions a week for several weeks or months.

The pace the program sets decides how long the rides run, so ask for it before quoting or booking.

How long 36 sessions take

At one session per visit, the ride count stays at 72 whatever the pace. Doubling up sessions halves it:

Intensive cardiac rehab runs on a different scale: as many as 72 hour-long sessions, with six allowed in a single day, all inside 18 weeks. Only programs on the CMS-approved list qualify, and the National Coverage Determinations Manual names three: the Pritikin Program, the Ornish Program for Reversing Heart Disease, and the Benson-Henry Institute Cardiac Wellness Program. Because only approved programs qualify, the nearest intensive program may be farther away than the nearest standard one, so check the distance before you price the series.

Who the riders are

Cardiac rehab riders are recovering from a heart event or living with heart disease. MedlinePlus notes a program may begin in the hospital and continue at a rehab center once the patient goes home. Medicare covers cardiac rehab after a heart attack in the past 12 months, bypass surgery, valve repair or replacement, an angioplasty or stent, or a heart or heart-lung transplant. It also covers current stable angina and stable chronic heart failure with an ejection fraction of 35 percent or less after at least six weeks of treatment. Our guide to transportation to physical therapy lists the same conditions next to the session limits.

Pulmonary rehab riders have moderate to very severe COPD, referred by the doctor treating it, or breathing problems lasting at least four weeks after COVID-19. Some travel with oxygen, which is covered below.

The program meets in a doctor’s office or a hospital outpatient department. The treatment plan has to be reviewed and signed by a physician every 30 days under both rules. That monthly signature is a natural point to confirm the ride schedule is still right.

Timing the pickup around a session

The rehab session itself is a known length, which makes these rides easier to plan than most medical appointments. MedlinePlus describes a typical session as a warm-up of about 5 minutes, about 20 minutes of aerobic exercise, and a cool-down of 5 to 15 minutes, sometimes with light weights. Add check-in, vital signs and education time, and ask the program what time patients usually walk out.

Medicare’s billing rules set a floor on how short a visit can be. Under the Claims Processing Manual, Chapter 32, section 140, a cardiac rehab session must last at least 31 minutes to be billed, and two sessions in one day need at least 91 minutes of treatment. A rider doing two sessions will be inside for well over an hour and a half, so book the return pickup to match.

A setup that keeps pickups on time:

1. Ask for the exact days and session time. The program sets them, and they can change as the rider progresses.
2. Ask where patients come out. A hospital outpatient department may have its own entrance, separate from the main lobby.
3. Set the return from the session end, not the start. Use the program’s real walk-out time.
4. Ask how the rider is after a session. The aim is 70 to 80 percent of maximum heart rate, according to MedlinePlus, and some riders leave tired.

Riders healing from bypass or a heart procedure

A rider a few weeks out from bypass surgery cannot be handled like any other ambulatory passenger. MedlinePlus discharge instructions for heart bypass surgery say:

• No driving for at least 4 to 6 weeks. Turning the steering wheel can pull on the incision, and the surgeon decides when driving is safe.
• Nobody pulls on the patient’s arms for 6 weeks. That includes help getting out of a bed or a seat, so a driver never pulls the rider up by the hands or arms.
• Arms stay close to the sides when getting out of a chair. Give the rider time to rise on their own.
• No reaching backward for 6 weeks. Hand the rider the seat belt instead of letting them twist to reach it.
• Lift nothing heavier than 5 to 7 pounds. The driver carries the gym bag, the oxygen and anything else.

After a cardiac catheterization, MedlinePlus tells patients with a groin insertion not to drive or lift heavy objects for at least 2 days, and patients with an arm insertion not to lift more than 10 pounds. Carrying bags for every cardiac rider is a sensible default.

Drivers are not clinicians. If a rider has chest pain, severe shortness of breath or faints on the way, the driver pulls over and calls 911. Our guide to a medical emergency during a ride covers what drivers do next.

Oxygen for pulmonary rehab riders

A pulmonary rehab rider who uses oxygen needs a supply that covers the whole outing. NHLBI says the rehab team may adjust a patient’s oxygen therapy during physical activity. The program must keep oxygen, CPR equipment and a defibrillator on site under 42 CFR 410.47, but that equipment is for treatment and emergencies, not for the ride home.

Ask three things at booking: the flow rate, whether the rider uses cylinders or a portable concentrator, and whether they carry a spare. Then count the time. As an example, a full aluminum E cylinder holds 680 liters of oxygen according to the manufacturer’s specification. At a continuous 2 liters a minute that lasts about 5 hours and 40 minutes. At 4 liters a minute it lasts under 3 hours, and a 30-minute ride each way plus a 90-minute visit uses 600 of the 680 liters.

Cylinders ride secured, never loose on a seat or the floor. Our glossary entry on portable oxygen covers securing and storing them in the vehicle.

Who pays for rehab rides

Who pays for the rehab and who pays for the ride are separate questions.

• Original Medicare. Part B pays for cardiac and pulmonary rehab, with the usual deductible and 20 percent coinsurance, plus a hospital copayment in an outpatient department. The only transportation it covers is a ground ambulance, and only when riding in another vehicle would put the patient’s health in danger (Medicare.gov). Our guide on whether Medicare covers NEMT explains the limits.
• Medicare Advantage. Some plans add rides as an extra benefit. Ask how many one-way trips a year the plan allows, because a full course alone can take 72. Our guide to Medicare Advantage rides covers how those benefits are booked.
• Medicaid. For full-benefit dual eligibles, CMS says in SMD 23-006 that the state must ensure transportation to a Medicaid-coverable service where Medicare is the primary payer. For other adults, the ride follows whether the state covers the rehab.
• The patient or family. A long course is easier to sell at a set price per round trip, agreed before the first session. Our guide to senior transportation rates shows how those are priced.

Keeping riders in the program

Most eligible patients never take part in cardiac rehab, and transportation is one of the reasons. Million Hearts, the federal heart disease prevention initiative, puts cardiac rehab participation between 19 and 34 percent in a national analysis and sets a goal of 70 percent. The collaborative’s road map, published in Mayo Clinic Proceedings in 2017, lists transportation issues among the barriers to attending and completing a program, next to cost, work and inconvenient hours.

A transportation company can remove that barrier for the riders it carries:

• Book the whole course at once. A standing order for every session saves the rider a call before each visit.
• Confirm the schedule monthly. Use the 30-day plan review to catch new days, added sessions or an early finish.
• Tell the program about missed rides. A missed session that was really a missed pickup should be fixed fast, not counted as the rider dropping out.
• End the series when the course ends. Session 36 ends a standard course unless the Medicare contractor approves more, and 72 is the most intensive cardiac rehab allows.

Running a rehab course in HealthRide

A rehab course is a recurring trip: schedule it once and HealthRide keeps it going, then end the series after the last session. Wheelchair, stretcher, and oxygen needs are matched, and each rider gets a reminder text ahead of every session plus another when the driver is on the way. See how recurring trips work.