Many of you have contacted us about the NCD for Cardiac Rehab, specifically the 93797 CPT code and its implication for use with education, counseling, and risk factor modification. We were originally told by Cahaba that these services would be covered under this code since the word “exercise” does not appear in the CPT description and it is clear by the language in 20-10 that CMS recognizes Cardiac Rehab as a program which must contain components other than exercise. Many of our hospitals put processes in place to bill for these components, such as nutrition education, risk factor modification, smoking cessation, and stress management.

We have been informed by Cahaba that the patient must exercise at each session in order to legitimately bill for these services. Dr. Greg McKinney, Cahaba Medical Director, attended a meeting where all of the Fiscal Intermediary CMDs were present. They were in agreement, that although "other" services are covered as part of the Cardiac Rehab (counseling, risk factors, etc.), each session must contain exercise.

As you well know, reimbursement issues surface regularly, and interpretations to the regulations can change. Please check back to the IACPR website for updates.