Wellcare CalViva Health Dual Align (HMO D-SNP): Supervised Exercise Therapy (SET)
Supervised exercise therapy (SET) is used to alleviate painful and disruptive symptoms associated with peripheral artery disease.
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Research has shown supervised exercise therapy (SET) to be an effective, minimally invasive method to alleviate the most common peripheral artery disease (PAD) symptom of intermittent claudication (painful to debilitating cramping in the leg induced by exercise and caused by obstruction of the arteries).
SET has been shown to be significantly more effective than unsupervised exercise and could prevent the progression of PAD and lower the risk of cardiovascular events that are prevalent in people with PAD.
SET has also been shown to perform at least as well as more invasive revascularization treatments.
SET is covered for members who have symptomatic peripheral artery disease (PAD). Up to 36 sessions over a 12-week period are covered if the SET program requirements 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
SET may be covered beyond 36 sessions over 12 weeks for an additional 36 sessions over an extended period of time if deemed medically necessary by a healthcare provider.
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