CMS Pub. 100-04, ch. 32, § 140.2.1

The following are the applicable Current Procedural Technology (CPT) codes for CR services:

93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation;

without continuous ECG monitoring (Per Session)

93798 Physician or other qualified care health professional services for outpatient cardiac rehabilitation; with

continuous ECG monitoring (Per Session)

Note: The above HCPCS descriptors are effective January 1, 2013.

Effective for dates of service on or after January 1, 2010, hospitals and practitioners may report a maximum of

2 1-hour sessions per day. In order to report one session of CR in a day, the duration of treatment must be at

least 31 minutes. Two sessions of CR may only be reported in the same day if the duration of treatment is at

least 91 minutes. In other words, the first session would account for 60 minutes and the second session would

account for at least 31 minutes if two sessions are reported. If several shorter periods of CR are furnished on a

given day, the minutes of service during those periods must be added together for reporting in 1-hour session

increments.

Example: If the patient receives 20 minutes of CR in the day, no CR session may be reported because less than

31 minutes of services were

furnished.

Example: If a patient receives 20 minutes of CR in the morning and 35 minutes of CR in the afternoon of a

single day, the hospital or practitioner would report 1 session of CR under 1 unit of the appropriate CPT code

for the total duration of 55 minutes of CR on that day.

Example: If the patient receives 70 minutes of CR in the morning and 25 minutes of CR in the afternoon of a

single day, the hospital or practitioner would report two sessions of CR under the appropriate CPT code(s)

because the total duration of CR on that day of 95 minutes exceeds 90 minutes.

Example: If the patient receives 70 minutes of CR in the morning and 85 minutes of CR in the afternoon of a

single day, the hospital or practitioner would report two sessions of CR under the appropriate CPT code(s) for

the total duration of CR of 155 minutes. A maximum of two sessions per day may be reported, regardless of the

total duration of CR.

sessions after 36 (to include completed ICR sessions prior to switch). In these cases, and consistent with the

information above, the -KX modifier must be included on the claim should the beneficiary participate in more

than 36 CR sessions following the switch.

See Pub. 100-06, Medicare Financial Management Manual, chapter 6, section 420, and Pub.

100-02, Medicare Benefit Policy Manual, chapter 15, section 232, and Pub. 100-08, Medicare

Program Integrity Manual, chapter 10, section 10.2.2.5 for detailed information regarding CR and ICR policy

and claims processing.