S9472, Cardiac rehabilitation program, non-physician provider, per diem
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- If billing CPT 93798 or other codes that indicate continuous ECG monitoring, documentation that continuous ECG monitoring was provided during the session
- Entry into such programs is based on the demonstrated limitation of functional capacity on exercise stress testing (i.e., exercise stress test results before entering the program).
- Medical evaluation documentation: 'Cardiac rehabilitation (CR) programs must include a medical evaluation ... prescribed exercise, education and counseling.'
- Progress reports: 'there should be regular communication, in the form of progress reports, between the program staff and the patient’s attending physician.'
Key Coverage Criteria
- Covered ICD-10 codes: Z51.89
- Covered ICD-10 codes: Z94.1
- Covered ICD-10 codes: Z94.2
- Covered ICD-10 codes: Z95.1
- Covered ICD-10 codes: Z95.2
- Covered ICD-10 codes: Z95.3
6 Active Policies
AETNA-CPB-0021, Cardiac Rehabilitation: Outpatient
AMBETTER-CP.MP.176, Outpatient Cardiac Rehabilitation
BCBSIL-THE803.023, Cardiac Rehabilitation in the Outpatient Setting
BCBSMT-THE803.023, Cardiac Rehabilitation in the Outpatient Setting
BCBSNM-THE803.023, Cardiac Rehabilitation in the Outpatient Setting
Related Codes
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