Cardiac Rehabilitation

CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00089N

Issue: Cardiac rehabilitation is described by the U.S. Public Health Service as consisting of "comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counseling". It further states that these programs "are designed to limit the physiologic and psychological effects of cardiac illness, reduce the risk for sudden death or reinfarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients". Medicare covers supervised cardiac rehabilitation as a physician service. The current Medicare policy covers physician supervised cardiac rehabilitation for patients who (1) have a documented diagnosis of acute myocardial infarction within the preceding 12 months; or (2) have had coronary bypass surgery; and/or (3) have stable angina pectoris. CMS (formerly HCFA) will evaluate whether or not current literature supports the use of supervised cardiac rehabilitation for the following additional indications: (1) heart valve replacement; (2) angioplasty; (3) heart or heart lung transplant; and (4) congestive heart failure. The review is limited to phase II rehabilitation programs. CMS will not consider acute inpatient programs or outpatient maintenance programs. We will be particularly interested in evidence bearing on the need for physician supervision in cardiac rehabilitation. If the evidence suggests that cardiac rehabilitation provides a benefit but that physician supervision is not required, it cannot be covered under the current statute. (A legislative change may be required to provide Medicare coverage in such instances, e.g., as a non-physician benefit.)