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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
- Coverage is provided for a maximum of 12 consecutive weeks if contract
- 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:
- Program specifications
- Location of the program
- Policy for handling medical emergencies
- Availability of physician during operating hours
- Medical director of program
- Staffing requirements, including staff to patient ratio