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
|Coverage Criteria|| Patients must meet one or more of the following: |
|Components|| Must include the following: |
|Coverage Criteria|| Pulmonary rehab services are for patients with moderate to very severe COPD |
|Stress Testing|| Reasonable for one or more of the following: |
|Frequency Edits|| |
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 firstname.lastname@example.org.
- 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)
Last Updated Aug 10, 2017