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Issue Number - Name
0135-Cardiac Rehabilitation
Review Type
Complex
Claim Type
Outpatient Hospital
Region and State
RAC 1-4
All A/B MACs
Date Approved
2019-01-08

Description

Cardiac rehabilitation (CR) is a physician-supervised program that furnishes physician prescribed exercise, cardiac risk factor modification, psychosocial assessment, and outcome assessment.  Medical Documentation will be reviewed to determine if cardiac rehabilitation is medically reasonable and necessary as well as meeting federal guidelines and Medicare coverage criteria.

Affected Codes

93797-Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG   monitoring (per session)
93798-Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
G0422-Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session
G0423-Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session

Applicable Policy References

Social Security Act: 1862 (a)(1)(A)
Social Security Act: 1833 (e)
Social Security Act: 1861 (s)(2)(CC)(e)
42 CFR Section 410.49
CMS Pub. 100-03, Medicare National Coverage Determinations, Section 20.10.1, 20.31, 20.31.1, 20.31.2, and 20.31.3
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 232
CMS Pub. 100-04, Medicare Claim Processing Manual, Chapter 32, Section 140
CMS Transmittal R1974CP, Issued 5/21/2010, Implementation Date 10/4/2010
CMS Transmittal R126BP, Issued 5/21/2010, Implementation Date 10/4/2010
CMS Transmittal R339PI, Issued 5/21/2010, Implementation Date 10/4/2010
Palmetto LCD L34412 Cardiac Rehabilitation, Effective Date 10/1/2015
Palmetto LCA A53775 Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Supplemental Instruction Article, Effective Date 10/1/2015