Superseded Local Coverage Article Billing and Coding

Billing and Coding: Outpatient Cardiac Rehabilitation

A54070

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Contractor Information

Article Information

General Information

Article ID
A54070
Article Title
Billing and Coding: Outpatient Cardiac Rehabilitation
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

Medicare covers cardiac rehabilitation (CR) services to beneficiaries as per Sections 1861(s)(2)(CC) and 1861(eee)(1) of the Social Security Act and 42CFR410.49 which defines key terms and the cardiac conditions that would enable a beneficiary to obtain CR services.

This article provides coding requirements for outpatient cardiac rehabilitation services.

Effective January 1, 2022, Cardiac Rehabilitation (CR) codes 93797 and 93798 have been assigned as category 3 codes on the Physician Fee Schedule List of Telehealth Services CY 2022 and will allow these services via telehealth until December 31, 2023.

Public Health Emergency Telehealth Services

Per MLN Matters® SE20011-Revised, when billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the PHE, bill with:

  • Place of Service (POS) equal to what it would have been had the service been provided in-person
  • Modifier 95, indicating that you provided the service via telehealth.

There are no billing changes for institutional claims. Critical access hospital method II claims should continue to bill with modifier GT.

Sources:

 

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

The Current Procedural Terminology (CPT) Manual codes appropriate for cardiac rehabilitation include:

Group 1 Codes
CodeDescription
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)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(80 Codes)
Group 1 Paragraph

The following diagnoses support cardiac rehabilitation:
*Use Z48.812 only to describe cardiac valvular repair for dates of service October 1, 2015 and after.

Group 1 Codes
CodeDescription
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I20.9 Angina pectoris, unspecified
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I50.22 Chronic systolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.812 Chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I5A Non-ischemic myocardial injury (non-traumatic)
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status
Z95.1 Presence of aortocoronary bypass graft
Z95.2 Presence of prosthetic heart valve
Z95.3 Presence of xenogenic heart valve
Z95.4 Presence of other heart-valve replacement
Z95.5 Presence of coronary angioplasty implant and graft
Z96.82 Presence of neurostimulator
Z96.89 Presence of other specified functional implants
Z98.61 Coronary angioplasty status
Z98.890 Other specified postprocedural states

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
013x Hospital Outpatient
085x Critical Access Hospital

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

CodeDescription
0943 Other Therapeutic Services - Cardiac Rehabilitation

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2022 R7

Noted 93797 & 93798 were assigned as category 3 codes on the Physician Fee Schedule List of Telehealth Services CY 2022 until December 31, 2023 per CR12549 and added how to bill for telehealth services.

10/01/2021 R6

Converted this article to a Billing and Coding article effective 04/28/20 and added I5A to the Group 1 ICD-10 Codes effective 10/01/2021.

10/01/2019 R5

Added ICD-10 code Z96.82 effective 10/01/2019 per the 2019 Annual update.

02/09/2018 R4

Effective date corrected from 2/8/2018 to 2/9/2018 to allow dx I50.82, I50.83, I50.84, I50.89 I50.812 and I50.814.

Corrected hyperlink for Transmittal 1798, CR 9982.

02/08/2018 R3

Added ICD-10-CM codes I21.21, I22.2, I22.9, Z98.890 effective 5/26/2017 and I50.82, I50.83, I50.84, I50.89 I50.812 and I50.814 effective 02/08/2018.

07/01/2017 R2

Per CR 9982 Clarified when providers can perform both Intensive Cardiac Rehab & Cardiac Rehab and switching between the two types effective 0701/2017. Also deleted the Group 2 Section for Intensive Cardiac Rehabilitation HCPCS codes which is covered in the IOM “Medicare Processing Manual”, Publication 100-4, Chapter 32, Section 140.3.

12/22/2016 R1 Article revised to add ICD-10 codes I21.01, I21.02, I22.0, I22.1 and I22.8 to the Group 1 ICD-10 codes effective 09/13/2016. Effective 12/22/16, this Local Coverage Article combines JFA A54069 into the JFB article A54070 so that both JFA and JFB contract numbers will have the same final MCD article number as JFB A54070.

Associated Documents

Related Local Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/14/2022 10/01/2022 - N/A Currently in Effect View
09/02/2022 10/01/2022 - N/A Superseded View
06/09/2022 01/01/2022 - 09/30/2022 Superseded View
03/03/2022 01/01/2022 - N/A Superseded View
01/20/2022 01/01/2022 - N/A Superseded You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Outpatient
  • Cardiac
  • Rehabilitation
  • 93797
  • 93798