Does G0423 require prior authorization?

Yes, G0423 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0423?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 2.05.

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`G0423`, Intensive cardiac rehabilitation; with or without continuous ecg monitoring;

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

2.05

Facility

N/A

Non-Facility

N/A

Documentation Required

ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim and supported by documentation in the patient's medical record.
Inclusion of the KX modifier on the claim line(s) is accepted as the provider's attestation that documentation verifying further treatment beyond standard session limits is on file and meets coverage requirements; the medical record must reflect medical reasons and be available to Medicare upon request.

If CR or ICR services involve electrocardiogram (ECG) monitoring, the medical record must document performance of such monitoring.

Reported CPT/HCPCS codes must accurately capture the service performed (e.g., CPT 93798, 93797; HCPCS G0422, G0423).

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).

Key Coverage Criteria

Cardiac rehabilitation (CR) is covered for beneficiaries with qualifying cardiac indications (e.g., myocardial infarction within 12 months).
CR is covered for beneficiaries with stable angina as an indication for CR.
An additional 36 CR sessions (Phase IIB) may be allowed if a significant intercurrent illness or comorbidity occurs during the first 36 sessions and the program exit criteria have not been met.
A new series of 36 CR sessions may be initiated and covered after an intervening event that qualifies as an indication for CR.
Intensive Cardiac Rehabilitation (ICR) is covered for qualifying indications and may consist of up to 72 one-hour sessions over a period up to 18 weeks.
Covered ICD-10 codes: Z51.89

9 Active Policies

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-FFF78083B324, Cigna Commercial Other Services Code List - Effective 03/07/2026

A53775, Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation

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

BCBSOK-THE803.023, Cardiac Rehabilitation in the Outpatient Setting

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G0423, Intensive cardiac rehabilitation; with or without continuous ecg monitoring;