Health Information Management

Tip: Know the common elements of cardiac and pulmonary rehabilitation programs

APCs Insider, December 10, 2010

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Cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) services became covered Medicare benefits in January. CR and PR programs must comply with Medicare guidelines for providers to receive payment. Physician supervision is one area where CMS includes very specific information that these programs must follow.

Some requirements are the same for both CR and PR programs. Comprehensive programs must include:

  • An individualized treatment plan
  • Psychosocial assessment
  • Physician-prescribed exercise
  • Education and/or counseling
  • Outcomes assessment

CR and PR programs may last for up to 36 one-hour sessions. A local Medicare contractor may authorize up to 36 additional visits based on a patient’s medical necessity.

CR and PR patients may attend one or two one-hour sessions of CR or PR daily. When a patient attends only one session per day, the session must be at least 31 minutes in duration. If a patient attends two sessions of CR or PR on the same day, the sessions must last for at least 91 minutes (60 minutes for the first session, and at least 31 minutes for the second). Exercise must occur in each PR session versus a minimum of one CR session per day. CMS does not address how much exercise is necessary during sessions because this depends on each patient’s ability.

This tip was adapted from “Are you meeting CMS’ physician supervision requirements for cardiac and pulmonary rehabilitation services?” in the December issue of Briefings on APCs.

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