2.0 DESCRIPTION
Cardiac rehabilitation is the
process by which individuals are restored to their optimal physical, medical,
and psychological status, after a cardiac event. Cardiac rehabilitation
is often divided into three phases. Phase I begins during inpatient
hospitalization and is managed by the patient’s personal physician.
Phase II is a medically supervised outpatient program which begins
following discharge. Phase III is a lifetime maintenance program
emphasizing continuation of physical fitness with periodic follow-up.
Each phase includes an exercise component, patient education, and
risk factor modification. There may be considerable variation in
program components, intensity and duration.
3.0 POLICY
3.1 Cardiac
rehabilitation services are cost-shared on an inpatient or outpatient
basis for services and supplies provided in connection with a cardiac
rehabilitation program when ordered by a physician and provided
as treatment for patients who have experienced the following cardiac
events within the preceding 12 months:
• Myocardial
infarction.
• Coronary artery bypass graft.
• Coronary angioplasty.
• Percutaneous transluminal coronary
angioplasty.
• Chronic stable angina.
• Heart valve surgery.
• Heart transplants, to include
heart-lung.
• Congestive Heart
Failure (CHF)/Stable Chronic Heart Failure (SCHF).
3.2 Payable benefits include separate
allowance for the initial evaluation and testing. Outpatient treatment
following the initial intake evaluation and testing is limited to
a maximum of 36 sessions per cardiac event, usually provided three
sessions per week for 12 weeks. Patient’s diagnosed with chronic stable
angina and CHF/SCHF are limited to
one treatment episode (36 sessions) in a calendar year.
5.0 Effective Dates5.1 Effective October
9, 1987, for myocardial infarction, coronary artery bypass graft,
coronary angioplasty, percutaneous transluminal coronary angioplasty,
and chronic stable angina.
5.2 Effective December
1, 1991, for heart valve surgery and heart transplants, to include
heart-lung.
5.3 Effective July
18, 2016, for CHF/SCHF.