Medicare covers cardiac rehabilitation exercise programs for patients who meet the following criteria:
• Have a documented diagnosis of acute myocardial infarction within the preceding 12 months; or
• Have had coronory bypass surgery; or
• Have stable angina pectoris; or
• Have had heart valve repair/replacement; or
• Have had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or
• Have had a heart or heart-lung transplant.
Effective for dates of services on or after March 22, 2006, services provided in connection with a cardiac rehabilitation exercise program may be considered reasonable and necessary for up to 36 sessions. Patients generally receive 2 to 3 sessions per week for 12 to 18 weeks. The contractor has discretion to cover cardiac rehabilitation services beyond 18 weeks. Coverage must not exceed a total of 72 sessions for 36 weeks.
Cardiac rehabilitation programs shall be performed incident to physician’s services in outpatient hospitals, or outpatient settings such as clinics or offices. Follow the policies for services incident to the services of a physician as they apply in each setting.
Coding Requirements
The following are applicable HCPCS codes:
• 93797 – Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
• 93798 – Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
