Cardiac Rehabilitation (Phase II Outpatient) - (0073)

Cigna covers physician‑supervised Phase II outpatient cardiac rehabilitation (CPT 93797, 93798) as medically necessary after specified cardiac events (e.g., recent MI, CABG, PCI, valve surgery, transplant, selected heart failure, VAD placement, sustained VT/VF, survivors of sudden cardiac arrest, refractory CAD) and specifically excludes Phase III/IV and intensive cardiac rehabilitation programs (HCPCS G0422, G0423, S9472). Coverage requires delivery in a physician’s office or hospital outpatient setting with a physician immediately available, physician‑prescribed daily exercise, documented risk‑factor modification, psychosocial and outcomes assessments, an individualized treatment plan reviewed and signed by a physician every 30 days, adherence to session limits (generally up to 36 one‑hour sessions, max two/day, extensions only if approved), appropriate coding, and avoidance when exercise contraindications are present (symptom‑limited stress test recommended before entry).