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National Coverage Determination (NCD)

Cardiac Rehabilitation Programs

20.10

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Tracking Information

Publication Number
100-3
Manual Section Number
20.10
Manual Section Title
Cardiac Rehabilitation Programs
Version Number
3
Effective Date of this Version
02/22/2010
Ending Effective Date of this Version
04/10/2023
Implementation Date
04/05/2010
Implementation QR Modifier Date

Description Information

Benefit Category
Incident to a physician's professional Service


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

A. General

(Rev. 116; Issued: 03-05-10; Effective Date: 02-22-10; Implementation Date: 04-05-10)

This section of the NCD Manual was repealed February 22, 2010, as a result of section 144 of the Medicare Improvements for Patients and Providers Act. Instead, refer to Pub. 100-04, chapter 32, section 140.
Indications and Limitations of Coverage
 
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
116
Coverage Transmittal Link
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R116NCD.pdf
Revision History

03/2010 - This section of the NCD Manual was repealed February 22, 2010, as a result of section 144 of the Medicare Improvements for Patients and Providers Act. Instead, refer to Pub. 100-04, chapter 32, section 140. Effective date: 02/22/2010. Implementation date: 04/05/2010. (TN 116) CR6855

04/2006 - The NCD Manual now includes a comprehensive description of the services that must be provided as part of a comprehensive cardiac rehabilitation program, extends the window of time during which the services must be provided and restructures the language for clarity. Effective date: 03/22/2006. Implementation date: 06/21/2006. (TN 52) CR4149

08/1989 - Clarified term "direct supervision" to mean a physician must be immediately available and accessible but not required to be physicially present in excercise room itself.  Effective date NA. (TN 41)

10/1985 - Clarified reimbursement limitation applied to freestanding clinics and coverage policy for physicial and occupational therapy. Effective date NA. (TN 2)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Cardiac Rehabilitation Programs - RETIRED 4 04/10/2023 - N/A View
Cardiac Rehabilitation Programs 3 02/22/2010 - 04/10/2023 You are here
Cardiac Rehabilitation Programs 2 03/22/2006 - 02/22/2010 View
Cardiac Rehabilitation Programs 1 08/01/1989 - 03/22/2006 View
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Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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