LCD for Cardiac Rehabilitation (L23499)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L23499 

 

LCD Title 

Cardiac Rehabilitation 

 

Contractor's Determination Number 

L23499 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

·  Title XVIII of the Social Security Act, Section 1862 (a)(7)
This section excludes routine physical examinations.

·  Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)
This section allows coverage and payment for only those services considered medically reasonable and necessary.

·  Title XVIII of the Social Security Act, Section 1833 (e)
This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

·  CMS Manual System, Pub 100-3, Cardiac Rehabilitation Programs, Section 20-10 (Coverage Issues Manual, section 35-25)
This section covers Cardiac Rehabiltation Programs.

·  Change Request 4401, Pub. 100-03 Medicare National Coverage Determinations, section 20.10
This transmittal provides expanded coverage for Cardiac Rehabilitation programs.

·  Change Request 5946, Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, Section 200.5 Billing and Payment for Cardiac Rehabilitation
 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
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California
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Connecticut
Florida
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Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
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Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 09/30/2006  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 03/10/2008  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

In accordance with IOM 100.3 (Coverage Issues Manual) Chpt. 1 Section 20.10, Cardiac rehabilitation is a comprehensive program of medical evaluation, monitored exercise, cardiac risk factor modification, education and counseling designed to medically benefit patients with coronary or valvular heart disease. Cardiac rehabilitation, as described in the medical literature, is divided into three phases: Phase I is the immediate in hospital post cardiac event phase; Phase II is the outpatient immediate post hospitalization recuperation phase; Phase III is the long term, maintenance phase. In accordance with the CIM, Medicare covers Phase II Cardiac Rehabilitation for for patients who: “(1) have a documented diagnosis of acute myocardial infarction within the preceding 12 months; or (2) have had coronary bypass surgery; or (3) have stable angina pectoris; or (4) have had heart valve repair/replacement; or (5) have had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; or (6) have had a heart or heart-lung transplant. ” The CIM specifies coverage for 2 to 3 sessions per week for up to 36 sessions over 12 to 18 weeks, with contractor discretion for additional sessions up to 72 sessions or 36 weeks. This LCD implements the diagnostic criteria and contractor discretion provisions of the NCD.

A. Riverbend will consider Cardiac Rehabilitation to be medically necessary in accordance with the NCD when it is initiated within 12 months of a qualifying event. Those events are:
· Myocardial infarction
· CABG
· Valve repair or replacement
· PTCA (with or without stent placement)
· Heart-lung transplant
When the time lag is greater than 1 year, Riverbend will consider the documented event to be incidental rather than causal.

In addition, Cardiac Rehabilitation is medically necessary for patients with active diagnoses of stable angina pectoris. For angina, all patients must have a pre-entry stress test or nuclear perfusion study that demonstrates exercise-induced ischemia within the 6 months prior to the start of cardiac rehabilitation. A positive stress test in this context implies a junctional depression of 2 mm or more with associated slowly rising ST segment, or 1 mm horizontal or down-sloping ST segment depressions.

B. Frequency and duration

Services at a frequency of less than 2 sessions per week or more than 3 sessions per week will be considered not medically necessary. Effective January 1, 2008, hospitals may report more than one unit of HCPCS 93797 or 93798 for a date of service if more than one session lasting at least one hour each is provided on the same day. In order to report more than one session for a given date of service, each session must last a minimum of 60 minutes.

Sessions exceeding 36 in number will be considered not medically necessary except in accordance with the extension criteria below.

C. Non-covered diagnoses and services

Use of any ICD-9-CM code not included in the "ICD-9-CM Codes That Support Medical Necessity" section of this LCD will be cause for denial of claims. Congestive heart failure in the absence of other covered conditions is not included as a covered condition for cardiac rehabilitation in accordance with the Coverage Issues Manual (100.3 Section 20-10.)

Cardiac rehabilitation exercise without continuous EKG monitoring is not medically necessary, therefore CPT 93797 is rarely covered. Clinical evaluations (other than the E&M evaluations of the refering and supervising physicians) are considered to be part of the cardiac rehabilitation benefit and count toward the total number of sessions. These evaluations may be performed at sessions that include monitored physical activity but may also be performed without monitored exercise. Sessions that consist of clinical evaluations, with or without education and ancillary services, but without monitored activity will only be considered to be medically necessary at the start and end of the program and at no more than 12 session intervals within the program. Note that this does not preclude evaluations as part of monitored sessions at any time, nor does it preclude medically necessary E&M sessions by physicians or non-physician practitioners. (See accompanying coding article.)

D. Extension Criteria--Duration of Program

1. The CIM permits Contractors to allow CR for up to 36 weeks. Riverbend will accept extensions of the time span for CR for up to a 36-week period as long as the medical record documents a reasonable explanation.

2. The CIM states that coverage shall not exceed 36 weeks. It does not mandate contiguous weeks, therefore Riverbend will allow interruptions in the span with due cause.
a. In counting weeks, Riverbend would not consider interruptions for reasons of health (e.g. rehospitalization, episode of illness, etc) to be part of the 36 week span and will not count those weeks as part of the 36 week limitation.
b. If the Cardiac Rehab program is interrupted for unforeseen reasons (patient fatigue, necessary travel, etc.), Riverbend would not consider the interruption to be part of the 36-week span and will not count those weeks as part of the 36-week limitation.
c. Holidays, provider vacations, inclement weather and intentionally light schedules (e.g. bi-weekly sessions) do not impact the 36 week limitation. (In the event of a natural disaster, Riverbend will automatically allow exception to the 36 week--but not the 36 session--limitation.)

3. Including interruptions, the program span may not continue beyond 88 weeks from the qualifying event, i.e. 52 weeks plus 36 weeks.

4. Note that there should still be a medical basis for breaks in the program as the literature supports early, not delayed, intervention.

E. Extension Criteria--Number of Sessions

Coverage is limited, except as defined below, to thirty-six sessions regardless of the number of weeks. Interruptions in a Cardiac Rehab program do not reset the 36 session limitation although they may allow additional sessions on a case by case basis.

1. If the beneficiary starts Cardiac Rehab, is interrupted for reasons of health or any other reason and then restarts the program, the count of sessions should continue where it left off regardless of the duration of the break.

2. If the beneficiary starts Cardiac Rehab, stops the program for any reason and then restarts the program with a different provider, the count of sessions should continue where it left off regardless of the duration of the break. It is therefore incumbent upon CR providers to obtain medical records from past CR providers.

3. Exceptions to the 36-session limitation will be granted on the following basis:
a. Riverbend will automatically approve an extension of 9 sessions in the event of a significant intercurrent illness or comorbidity during CR AND exit criteria are not met. Documentation must be available on request to show that exit criteria have not been met. (Patient endurance and progress are likely to be impaired.)

Exit criteria are considered met when the patient has achieved a stable level of exercise tolerance (7 METS). In the American Heart Association’s functional classification, Class I, or normal function status, begins at 7 metabolic equivalent units (METS). Therefore, completion of 6 minutes of exercise during a treadmill or stress imaging test, utilizing the Bruce protocol, without significant ischemia or dysrhythmia is a reasonable exit criterion. Although the exit criterion only applies definitively to extensions beyond the initial 36 sessions, facilities are encouraged to apply that criterion to the initial 36 sessions for patients with ischemic heart disease as well.

F. Rentry Criteria

The NCD Decision Memorandum specifies that it is CMS' intention to consider medical necessity on a per-episode basis.

If the beneficiary has a second qualifying event at any time, the 36 session counter is considered to be re-set at 0 regardless of the current status within a program or the time lapse since the completed program.
1. The definition of a new event is self-explanatory in the case of MI, PTCA or cardiac surgery.
2. Angina, being a condition rather than an event, will be considered to be a new event if the patient has recurrent symptoms following a two year period with no symptoms, no treatment and no positive diagnostic tests since the last "qualifying" episode of angina OR if the patient has a recurrent positive diagnostic test following a negative test of equal or greater sensitivity and the patient was not being treated for angina. Typically these situations would be expected to occur when a patient is treated with an interventions such as PTCA, becomes symptom (and diagnosis) free, and then suffers a recurrence several years later. 

 

Coverage Topic 

Cardiac Rehabilitation Program
 

 

Coding Information

Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

13x

Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)

21x

SNF-inpatient, Part A

22x

SNF-inpatient or home health visits (Part B only)

74x

Clinic-ORF only (eff 4/97); ORF and CMHC (10/91 - 3/97)

 

 

Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0943

Other therapeutic services-cardiac rehabilitation

 

 

CPT/HCPCS Codes 

 

93797

PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING (PER SESSION)

93798

PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG MONITORING (PER SESSION)

 

 

ICD-9 Codes that Support Medical Necessity 

TRUNCATED DIAGNOSIS CODES ARE NOT ACCEPTABLE.

ICD-9-CM code listings may cover a range and include truncated codes. It is the provider’s responsibility to avoid truncated codes by selecting a code(s) carried out to the highest level of specificity and selected from the ICD-9-CM book appropriate to the year in which the service was performed.

It is not enough to link the procedure code to a correct, payable ICD-9-CM code. The diagnosis or clinical signs/symptoms must be present for the procedure to be paid, and the servcie must be performed specifically for that diagnosis or condition.

410.00 - 410.02

ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.10 - 410.12

ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.20 - 410.22

ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.30 - 410.32

ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.40 - 410.42

ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE

410.50 - 410.52

ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE

410.60 - 410.62

TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED - TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE

410.70 - 410.72

SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED - SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE

410.80 - 410.82

ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE

410.90 - 410.92

ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE

412

OLD MYOCARDIAL INFARCTION

413.0 - 413.9

ANGINA DECUBITUS - OTHER AND UNSPECIFIED ANGINA PECTORIS

V42.1

HEART REPLACED BY TRANSPLANT

V42.2

HEART VALVE REPLACED BY TRANSPLANT

V43.3

HEART VALVE REPLACED BY OTHER MEANS

V45.81

POSTSURGICAL AORTOCORONARY BYPASS STATUS

V45.82

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY STATUS

V58.73

AFTERCARE FOLLOWING SURGERY OF THE CIRCULATORY SYSTEM NOT ELSEWHERE CLASSIFIED

 

 

Diagnoses that Support Medical Necessity 

N/A 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

Use of any ICD-9-CM code not listed in the “ICD-9-CM Codes that Support Medical Necessity” section of this LCD will be denied.

 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

1.Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will be returned.

2.The qualifying event must be recorded in the patient's medical record maintained by the cardiac rehabilitation provider. This information may include copies of the referring physician's records or reports. A prescription for cardiac rehabilitation from the referring physician must be maintained in the patient's medical record by provider of cardiac rehabilitation.

3.Documentation must be available to Medicare upon request.

 

 

Appendices 

 

 

Utilization Guidelines 

Services at a frequency of less than 2 sessions per week will be considered not medically necessary.

 

 

Sources of Information and Basis for Decision 

1. Empire LCD
2. Heart Disease: A Textbook of Cardiovascular Medicine; 5th Edition; edited by Braunwald, Eugene; Chapter 40, Rehabilitation of Patients with Coronary Artery Disease; Dennis, Charles.
3. Rodriguez, Orlando, MD, et al, "Components of Cardiac Rehabilitation and Exercise Prescription", UpToDate, October 19, 2001.
4. Fletcher, BJ, et al, "Phase II intensive monitored cardiac rehabilitation for coronary artery disease and coronary risk factors - a six session protocol", Am.J Cardiol, 1986, Apr 1; 57 (10):751-6.
5. Fletcher, BJ, et al, "Outpatient rehabilitative training in patients with cardiovascular disease: emphasis on training method", Heart Lung, 1988 Mar;17(2):199-205.
 

 

Advisory Committee Meeting Notes 

 

 

Start Date of Comment Period 

06/30/2006 

 

End Date of Comment Period 

08/15/2006 

 

Start Date of Notice Period 

08/16/2006 

 

Revision History Number 

R2 

 

Revision History Explanation 

R1 Released for notice.

10/30/2007 - Review with no changes

2/18/2008 - The description for Bill code 21 was changed

03/10/2008 – Frequency and Duration update from CR 5946

03/11/2008 - Date corrected Rivision History Explanation 

 

Reason for Change 

Typographical Correction
 

Last Reviewed On Date 

03/11/2008 

 

Related Documents 

This LCD has no Related Documents.

 

LCD Attachments 

Comment and Response - Comment and Response (20,985 bytes)

 

Other Versions 

Updated on 03/10/2008 with effective dates 03/10/2008 - N/A

Updated on 02/18/2008 with effective dates 09/30/2006 - 03/09/2008

Updated on 10/30/2007 with effective dates 09/30/2006 - N/A

Updated on 10/11/2006 with effective dates 09/30/2006 - N/A