Coverage of cardiac rehabilitation (CR and ICR) furnished on or after January 1, 2010, has been updated by CMS. There have been no changes in the diagnoses which meet the criteria for cardiac rehabilitation programs.
The Current Procedural Terminology (CPT) Manual codes appropriate for cardiac rehabilitation include:
CPT Codes 93797 Description Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
CPT Codes 93798 Description Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)
Intensive Cardiac Rehabilitation CPT Codes G0422 Description Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session
CPT Codes G0423 Description Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session
When staff, other than a physician/non-physician practitioner, provides cardiac rehabilitation services, documentation must support physician supervision and otherwise meets the CMS requirements for these programs.
The following diagnoses support cardiac rehabilitation:
* 410.02 - Acute Myocardial infarction of anterolateral wall subsequent episode of care * 410.12 - Acute Myocardial infarction of other anterior wall subsequent episode of care * 410.22 - Acute Myocardial infarction of inferolateral wall subsequent episode of care * 410.32 - Acute Myocardial infarction of inferoposterior wall subsequent episode of care * 410.42 - Acute Myocardial infarction of other inferior wall subsequent episode of care * 410.52 - Acute Myocardial infarction of other lateral wall subsequent episode of care * 410.62 - Acute Myocardial infarction true posterior wall infarction subsequent episode of care * 410.72 - Acute Myocardial infarction subendocardial infarction subsequent episode of care * 410.82 - Acute Myocardial infarction of other specified sites subsequent episode of care * 410.92 - Acute Myocardial infarction unspecified site subsequent episode of care * 412 - Old Myocardial Infarction * 413.0 - Angina decubitus * 413.1 - Prinzmetal angina * 413.9 - Other and unspecified angina pectoris * 414.02 - Coronary atherosclerosis of autologous vein bypass graf * 414.03 - Coronary atherosclerosis of nonautologous biological bypass graft * 414.04 - Coronary atherosclerosis of artery bypass graft * 414.05 - Coronary atherosclerosis of unspecified type of bypass graft * 414.06 - Coronary atherosclerosis of native coronary artery of transplanted heart * 414.07 - Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart * 414.8 - Other specified forms of chronic ischemic heart disease * 414.9 - Chronic ischemic heart disease, unspecified * V42.1 - Heart Transplant * V42.2 - Heart Valve Transplant * V43.3 - Heart Valve Replacement * V43.89 - Other Organ or Tissue Replacement (Use this code for Heart/Lung Transplant) * V45.81 - Aortocoronary Bypass * V45.82 - Percutaneous Transluminal Coronary Angioplasty * V58.73-Aftercare following surgery of the circulatory system, NEC (This code should only be used to describe cardiac valvular repair [dates of service May 30, 2008 and after])
Source: Source: Internet Only Manual (IOM) Medicare Benefit Policy Manual, Publication 100-02,- Chapter 15, Section 60; IOM Medicare General Information, Eligibility and Entitlement Manual, Publication 100-01, Chapter 5, Section 70.7; IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 140; Transmittal 126, CR6850 dated May 21, 2010; Transmittal 1974, CR6850 dated May 21, 2010; Transmittal 339, CR6850 dated May 21, 2010; Transmittal 170, CR6850 dated May 21, 2010; Transmittal 125, CR7113 dated September 24, 2010
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