Medicare Coverage of Cardiac Rehabilitation
When you have a heart condition, a doctor-supervised rehabilitation program, tailored to your individual needs, can help get your heart back into shape, reduce your risk factors and improve the quality of your life.
Medicare will cover a cardiac rehabilitation program if you have had any of the following illnesses:
- A heart attack in the last 12 months
- Coronary artery bypass surgery
- Current stable angina pectoris
- A heart valve repair or replacement
- A coronary angioplasty or coronary stent
- Had a percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting - which widens an artery so blood can pass through more easily; and/or
- A heart or heart-lung transplant
- Stable chronic heart failure
ICR programs are also covered if:
- Your doctor orders it
- You've had any of the conditions listed above, with the exception of stable chronic heart failure, which applies only to CR programs
- Depending upon your needs, your doctor will either prescribe a general or intensive cardiac rehabilitation program.
In addition, you must:
- Have your doctor prescribe the program for you;
- Get services under the supervision of a doctor at the outpatient department of a hospital or in a doctor’s office ; and
- Take part in a comprehensive program that includes:
- Physician prescribed exercises for each cardiac rehabilitation visit
- A program to modify cardiac risk factors (such as nutritional counseling and education)
- Assessment of outcomes
- Psychosocial assessment to look at an individual’s mental and emotional needs that affect their rehabilitation.
- Individualized treatment plan
Medicare will pay for up to two one-hour long sessions per day for up to 36 sessions over 36 weeks. If medically necessary, Medicare will cover an additional 36 sessions. If you qualify for intensive rehabilitation services, Medicare will pay for up to six one-hour long sessions per day for up to 72 sessions over 18 weeks.
If you receive the services, in a doctor’s office, Medicare will pay 80% of the Medicare-approved amount after you have paid the Part B deductible. If you receive the services in a hospital outpatient department, you will pay a copayment that can be no more than the Part A hospital deductible.
How often is it covered?
Medicare Part B (Medical Insurance) covers comprehensive cardiac rehabilitation (CR) programs that include exercise, education, and counseling. Part B also covers intensive cardiac rehabilitation (ICR) programs that, like regular CR programs, include exercise, education, and counseling. ICR programs are typically more rigorous or more intense that CR programs. These programs may be provided in a hospital outpatient setting (including a critical access hospital) or in a doctor's office.