Cardiac and Pulmonary Rehabilitation Programs - JE Part B
Cardiac and Pulmonary Rehabilitation Programs
Medicare established coverage provisions for Cardiac Rehabilitation (CR) and Pulmonary Rehabilitation (PR) programs. The regulation at 42 CFR 410.49 includes coverage provisions for CR and PR items and services, physician standards and limitations to the sessions that may be covered.
- Cardiac Rehabilitation (CR) Program
- Pulmonary Rehabilitation (PR) Program
- CR, Intensive Cardiac Rehabilitation (ICR) and PR Orders
Patients must meet one or more of the following:
Must include the following:
Pulmonary rehab services are for patients with moderate to very severe COPD (defined as GOLD classification II, III, IV), when referred by the physician treating chronic respiratory disease; Who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks (effective January 1, 2022). Additional medical indications for coverage may be established through an NCD.
To comply with federal statute, Medicare covered CR, ICR and/or PR services must be ordered by a Medical Doctor or Doctor of Osteopathy licensed in the state where the services are rendered. For either CR, ICR or PR, the medical director or supervising MD/DO must be present and immediately available during rehab activities.
The sole exception, per § 512.630, is for a provider or supplier of CR and ICR services to an Episode Payment Model beneficiary during an AMI and CABG episode, as defined in § 512.2, wherein CMS waives the physician definition to allow the functions of supervising physician, prescribing exercise, and establishing, reviewing, and signing an individualized treatment plan for CR and ICR services to be furnished under the direction of:
- A physician, as defined in section 1861(r)(1) of the Act; or
- A qualified nonphysician practitioner, as defined by CMS.
Questions regarding Advancing Care Coordination through Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model can be directed to email@example.com.
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6.9, 20.6.10, and 61.3-61.3.6
- CMS Medicare Learning Network (MLN) Matters (MM)6850 – Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
- CMS MM6823 – Pulmonary Rehabilitation (PR) Services
- Cardiac Rehabilitation Programs (20.10) National Coverage Determination (NCD)
- CMS Change Request (CR)12613 - Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage
Last Updated Wed, 29 Jun 2022 16:23:43 +0000