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Cardiac rehabilitation is the process by which people with cardiovascular disease are restored to their optimal functional status, including their physiological, psychological, social, vocational, and emotional status. Cardiac rehabilitation services include formal exercise sessions, risk factor education, and behavior modification counseling. Phase II cardiac rehabilitation is immediate outpatient therapy during the convalescent period following hospital discharge. Individualization of the program is achieved through a case management perspective with attention to patient and family needs.
Case Management approval is required for underwritten and most self-funded groups.
Phase II Cardiac Rehabilitation
Phase II cardiac rehabilitation (immediate outpatient therapy during the convalescent period following hospital discharge) may be offered to patients with the following cardiovascular disease diagnoses (qualifying episodes) including:
Contraindications for participation in Phase II cardiac rehabilitation include:
Minimal guidelines for risk stratification are as follows:
Phase II cardiac rehabilitation may include continuous or intermittent ECG monitoring based on the patient’s risk level. The type and frequency of ECG monitoring should be determined on a patient-by-patient basis. Minimum guidelines to follow are:
Initiation of Service
Formal cardiac rehabilitation service should be initiated within 3 months after discharge from the hospital.
Frequency and Duration of Service
Patient education and risk factor modification are considered part of the formal cardiac rehabilitation service.
Patients who are determined appropriate for cardiac rehabilitation based on recommendation by the referring physician and on patient selection criteria as outlined above are eligible for formal cardiac rehabilitation services.
The number of visits covered is based on patient severity as follows:
Three factors determine the appropriateness of discontinuing the cardiac rehabilitation program. These include:
The final decision as to risk determination shall be the joint responsibility of the referring physician and the director of the cardiac rehabilitation program (added 7-9-2001).
Place of Service
Formal cardiac rehabilitation services must be conducted at a facility meeting the following criteria:
The following programs are certified by AACVPR in
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY2/1999: Approved by the Medical Policy Advisory Committee (MPAC)
9/19/2000: Revisions to "Place of Service; "may" changed to "must" and the programs certified by AACVPR for Cardiac and Pulmonary Rehabilitation added
7/10/2001: Certified hospitals as of 5-31-2001 table added to "Place of Service", word "Pulmonary" deleted. This policy is specific to Cardiac Rehabilitation only.
8/2001: Reviewed by MPAC
9/20/2001: Natchez Regional Medical Center added to the Mississippi AACVPR certified program list
12/11/2001: Covered ICD-9 Procedure codes, ICD-9 Diagnosis codes, and Non-Covered ICD-9 Diagnosis codes added to the "Code Reference" section.
1/9/2002: Clay County Medical Center, North Mississippi Health Services and Oktibbeha County Hospital added to AACVPR certified program list
4/18/2002: Type of Service and Place of Service deleted.
5/14/2002: AACVPR table hyperlink added
5/29/2002: Code Reference section updated, ICD-9 procedure codes 36.11-36.17, 36.01-36.09 and 37.5 deleted
7/17/2002: Appeals statement deleted. Case Management reference deleted (depends on individual contract). Policy Guidelines statement added.
10/11/2002: ICD-9 Procedure code 89.44 deleted, HCPCS S9445 deleted
2/14/2003: AACVPR table updated, AACVPR hyperlink and separate AACVPR file deleted
6/12/2003: FEP Policy Exception deleted for Case Management and prior authorization, Case Management approval requirement added for underwritten and most self funded groups
6/18/2003: Magnolia Regional Health Center Cardiac Rehabilitation Program added to AACVPR certified program list
8/26/2003: Delta Regional Medical Center Cardiac Rehabilitation Program added to AACVPR certified program list
9/8/2003: Jackson Rehab and Wellness Center and Baptist Memorial Hospital DeSoto Cardiac Rehabilitation Programs added to AACVPR certified program list
9/18/2003: Hancock Medical Center Cardiac Rehabilitation Program added to AACVPR certified program list
10/10/2003: University of Mississippi Medical Center Cardiac Rehabilitation Center added to AACVPR certified program list
3/26/2004: Central Mississippi Medical Center, Garden Park Medical Center and Baptist Memorial Hospital at Oxford Cardiac Rehabilitation programs added to AACVPR certified program list
9/9/2004: Code Reference section updated, CPT code 93015, 93016 deleted covered codes, ICD-9 procedure code 93.36 added covered codes, ICD-9 diagnosis code range 410.00-410.92, 414.00-414.9, 427.0-427.9, 443.0-443.9 listed separately, ICD-9 diagnosis codes 426.10, 426.11, 426.12, 426.13, 426.2, 426.3, 426.4, 426.50, 426.51, 426.52, 426.53, 426.54, 426.6, 426.7, 426.81, 426.89, 426.9, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.30, 440.31, 440.32, 440.9, 441.00, 441.01, 441.02, 441.03, 441.1, 441.2, 441.3, 441.4, 441.5, 441.6, 441.7, 441.9, 442.0, 442.1, 442.2, 442.3, 442.81, 442.82, 442.83, 442.84, 442.89, 442.9, 459.81, 671.30, 671.31, 671.32, 671.33, 671.34, 671.40, 671.41, 671.42, 671.43, 671.44, V45.81, V45.82 added covered codes, rev code 943 deleted, non-covered table and codes 250.00-250.93, 411.1, 420.90, 420.91, 420.99, 422.90, 422.91, 422.92, 422.99, 424.1, 426.0, 428.0, 433.00-433.91, 434.1, 451.0-451.9, 780.6 deleted
10/5/2004: Singing River Hospital System/Ocean Springs Hospital Cardiac Rehabilitation added AACVPR certified program list
7/18/2005: AACVPR table updated, Southwest Mississippi Regional Medical Center Cardiac Rehabilitation added to AACVPR certified program list
9/15/2005: AACVPR table updated, Greenwood Leflore Hospital Cardiac Rehabilitation Department added to AACVPR certified program list
6/14/2006: AACVPR table updated, River Region Health System Cardiac Rehabilitation added to AACVPR certified program list
09/13/2006: Coding updated. ICD9 2006 revisions added to policy.
9/20/2007: Code reference section updated. ICD-9 2007 revisions added policy
9/19/2008: Annual ICD-9 updates effective 10-1-2008 applied
3/12/2010: Code reference section updated. New HCPCS codes G0422 and G0423 added to covered table.
06/04/2010: Memorial Hospital at Gulport Cardiac Rehabilitation Program added to AACVPR certified program list.
12/30/2010: Added "in the Outpatient Setting" to the policy title.
08/11/2011: Policy reviewed; no changes.
05/07/2013: Removed ICD-9 procedure code 93.36 from the Code Reference section.
A search of the literature was completed through the MEDLINE database for the period of January 1990 through October 1996. The search strategy focused on references containing the following Medical Subject Heading: Cardiac Rehabilitation.
Cardiac Rehabilitation, Clinical Practice Guideline, Number 17, U.S. Department of Health & Human Services, October 1995.
American Association of Cardiovascular and Pulmonary Rehabilitation
Hayes Medical Technology Directory
Blue Cross Blue Shield Association policy # 8.03.08 (added 7-16-2001)
HCFA, Coverage Issues Manual, section 35-25 (added 8-16-2001)
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.