The following Noridian coverage requirements for the Billing and Coding Outpatient Cardiac Rehabilitation National Coverage Determination (NCD) have been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

NCD: Outpatient Cardiac Rehabilitation 20.10.1

Effective Date: January 1, 2022

Summary of Changes: Updated the Coverage criteria and the use of the KX modifier to indicate the additional 36 services are medically necessary for Outpatient Cardiac Rehabilitation Services in the Article Text.

Also added the KX modifier to the CPT/HCPCS Modifiers section.

Removed ICD-10-CM code I50.32 - Chronic diastolic (congestive) heart failure from the ICD-10 Codes that Support Medical Necessity section.

Visit the National Coverage Determination (NCD) webpage to view the NCD coverage articles.