Cardiac Rehabilitation in the Outpatient Setting

Covers medically supervised outpatient cardiac rehabilitation—comprehensive, guideline‑based programs (medical evaluation, physician‑prescribed exercise, risk‑factor modification, psychosocial assessment, individualized treatment) for patients after acute myocardial infarction (within 12 months), coronary artery bypass grafting, PCI/coronary stenting, heart valve or heart/heart–lung transplantation, current stable angina, compensated heart failure, and other diagnosed coronary or cardiac disease. Coverage is limited to 3 sessions/week for up to 12 weeks (maximum 36 sessions), should begin within 90 days and be completed within 6 months of the qualifying event; repeat participation without a new qualifying event, intensive programs (e.g., Ornish, Pritikin), virtual cardiac rehab, and PT/OT for the same cardiac diagnosis are not covered.

"Acute myocardial infarction (heart attack) within the preceding 12 months"