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 (MI).
• Coronary Artery Bypass Graft
(CABG).
• Coronary angioplasty.
• Percutaneous Transluminal Coronary
Angioplasty (PTCA).
• 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 Dates
5.1 Effective October 9, 1987,
for MI, CABG, coronary angioplasty, PTCA, 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.