National Coverage Determination (NCD)

Benson-Henry Institute Cardiac Wellness Program

20.31.3

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Tracking Information

Publication Number
100-3
Manual Section Number
20.31.3
Manual Section Title
Benson-Henry Institute Cardiac Wellness Program
Version Number
1
Effective Date of this Version
05/06/2014
Implementation Date
11/04/2014

Description Information

Benefit Category
Intensive Cardiac Rehabilitation Program


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

A.      General

The fundamental concepts of the Benson-Henry Institute Cardiac Wellness Program were developed by Herbert Benson, MD, over 40 years ago. Benson states that “in the middle 1960s, when I noticed that people’s blood pressures were higher during visits to my office than at other times and wondered whether stress wasn’t causing that rise. Stress wasn’t on the radar then, so I began investigating a connection between stress and hypertension.” (http://www.ideafit.com/fitness-library/mind-body-medicine-balanced-approach) The Cardiac Wellness Program is a multi-component intervention program that includes supervised exercise, behavioral interventions, and counseling, and is designed to reduce cardiovascular risk and improve health outcomes.

Indications and Limitations of Coverage

B.      Nationally Covered Indications

Effective for claims with dates of service on and after May 6, 2014, the Benson-Henry Institute Cardiac Wellness Program meets the Intensive Cardiac Rehabilitation (ICR) program requirements set forth by Congress in §1861(eee)(4)(A) of the Social Security Act, and in regulations at 42 C.F.R. §410.49(c) and, as such, has been included on the list of approved ICR programs available at http://www.cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/.

C.      Nationally Non-Covered Indications

Effective May 6, 2014, if a specific ICR program is not included on the above-noted list as a Medicare-approved ICR program, it is non-covered.

D.      Other

N/A

(This NCD last reviewed May 6, 2014.)

Claims Processing Instructions

Transmittal Information

Transmittal Number
175
Revision History

10/2014 - Effective for dates of service on and after May 6, 2014, Medicare determined that the evidence is sufficient to expand the ICR benefit to include the Benson-Henry Institute Cardiac Wellness Program. Implementation date: 11/04/2014. (TN 175) (CR 8894)

02/2017 - This change request (CR) is the 11th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates as follows: CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, CR9631, CR9751, and CR9861, as well as in CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. (TN 1798) (CR9982)

05/2017 - This change request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html, along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. (TN 1854) (CR10086)

05/2019 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html, along with other CRs implementing new policy NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.(TN 2298) (CR11229)

10/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11068) (CR12480)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Additional Information

Other Versions
Title Version Effective Between
Benson-Henry Institute Cardiac Wellness Program 1 05/06/2014 - N/A You are here