Cardiac Rehabilitation CPT Codes 93797, 93798 and Revenue Code 943

Description of Procedure

• Cardiac rehabilitation program is a reconditioning program primarily for individuals who have coronary heart disease (CHD) or heart failure.
• By engaging in medically supervised exercise monitoring activities, the patient strengthens heart muscle, improves circulation and general condition in hopes of preventing an attack or the recurrence of one.
• The program consists of diagnostic screening procedures and exercises with monitoring. Claims include charges for graded exercise tests (treadmill evaluation), telemetry monitoring, and cardiovascular therapy (exercise).

Coverage and Billing

• Coverage is provided for a maximum of 36 sessions during a 12-week period for Regular Business contracts.
• Benefits provided for repeat exercise test/stress test (93015-93018) when there is a change in the patient's clinical status. The repeat test is not normally considered part of the cardiac rehabilitation.
• Cardiac rehabilitation programs are considered medically necessary for patients with a history of one of the following conditions and/or procedures:
  • acute myocardial infarction (MI) (heart attack)
  • coronary artery bypass graft (CABG) surgery
  • percutaneous transluminal coronary angioplasty (PTCA)
  • heart valve surgery
  • heart transplantation
  • stable angina pectoris
  • compensated heart failure
• Therapy must begin within one year of surgery or diagnosed condition listed above.
• Coverage is provided for a maximum of 12 consecutive weeks if contract is BellSouth.
• Effective 11/15/99, benefits are provided if contract is FEP.
• This is a Major Medical benefit only.
• Facility must be approved for Cardiac Rehabilitation

For approval of cardiac rehabilitation services, you should submit the following information to your Network Services Representative:

1. Program specifications
2. Location of the program
3. Policy for handling medical emergencies
4. Availability of physician during operating hours
5. Medical director of program
6. Staffing requirements, including staff to patient ratio