Cardiac Rehabilitation Programs for Chronic Heart Failure
NCD359
CMS nationally covers cardiac rehabilitation for beneficiaries with stable chronic heart failure who have LVEF ≤ 35% and NYHA class II–IV symptoms despite optimal therapy for ≥6 weeks, provided they have had no major cardiovascular hospitalizations in the prior 6 weeks and no planned major procedures within 6 months. Cardiac rehabilitation is also covered for specified post-cardiac events/procedures (AMI within 12 months, CABG, stable angina, valve repair/replacement, PTCA/stenting, and heart or heart–lung transplant); any cardiac indication not specified in 42 CFR §410.49(b)(1)(vii) or in this or another NCD is non-covered. Documentation must demonstrate LVEF, NYHA class, duration of optimal therapy, and the patient’s stability; the NCD references 42 CFR §410.49 for program requirements and session limits.
"Beneficiaries with stable, chronic heart failure defined by left ventricular ejection fraction (LVEF) ≤ 35% and New York Heart Association (NYHA) class II–IV symptoms despite receiving optimal hear..."