Medicine
Chapter 7
Section 11.1
Cardiac
Rehabilitation
Issue Date: November 1, 1983
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision: C-1, March 10, 2017
1.0 CPT PROCEDURE CODE RANGE
93797 - 93798
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.
4.0 EXCLUSION
Phase III cardiac rehabilitation
for lifetime maintenance performed at home or in medically unsupervised
settings.
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.
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