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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