CMS Pub. 100-03, ch. 1, § 20.10.1

A. General

As per sections 1861(s)(2)(CC) and 1861(eee)(1) of the Social Security Act, items and

services furnished under a Cardiac Rehabilitation (CR) program may be covered under

Medicare Part B. Among other things, Medicare regulations at 42CFR410.49 define key

terms, address the components of a CR program, establish the standards for physician

supervision, and limit the maximum number of program sessions that may be furnished.

The regulations also describe the cardiac conditions that would enable a beneficiary to

obtain CR services.

Effective for dates of service on and after January 1, 2010, coverage is permitted for

beneficiaries who have experienced one or more of the following:

• Acute myocardial infarction within the preceding 12 months

• Coronary artery bypasses surgery

• Current stable angina pectoris

• Heart valve repair or replacement

• Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting

• A heart or heart-lung transplant

The Centers for Medicare & Medicaid Services (CMS) may add “other cardiac conditions

as specified through a national coverage determination” (See 42 CFR §410.49(b)(1)(vii).

B. Nationally Covered Indications

Effective for dates of service on and after February 18, 2014, CMS has determined that

the evidence is sufficient to expand coverage for cardiac rehabilitation services under 42

CFR § 410.49(b)(1)(vii) to beneficiaries with stable, chronic heart failure, defined as

patients with left ventricular ejection fraction of 35% or less and New York Heart

Association (NYHA) class II to IV symptoms despite being on optimal heart failure

therapy for at least six weeks. Stable patients are defined as patients who have not had

recent (≤6 weeks) or planned (≤6 months) major cardiovascular hospitalizations or

procedures. (See section A above for other indications covered under 42 CFR

§410.49(b)(1)(vii).

C. Nationally Non-Covered Indications

Any cardiac indication not specifically identified in 42 CFR § 410.49(b)(1)(vii) or

identified as covered in this NCD or any other NCD in relation to cardiac rehabilitation

services is considered non-covered.

D. Other

NA

(This NCD last reviewed February 2014.)