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Changes in Store for Cardiac and Pulmonary Rehabilitation for 2010

November 24, 2009:

Cardiac and pulmonary rehabilitation will undergo some changes in 2010, thanks to new benefit categories and new HCPCS codes.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) added new Medicare benefit categories for cardiac and pulmonary rehabilitation services, beginning January 1, 2010. The Centers for Medicare and Medicaid Services (CMS) has established outpatient prospective payment for new, comprehensive pulmonary and intensive cardiac rehabilitation services furnished to patients with chronic obstructive pulmonary disease, cardiovascular disease, and related conditions.

CMS announced the annual modifications to HCPCS codes on November 2, 2009. The HCPCS Level II code set is one of the standard code sets used for claims processing by Medicare, Medicaid, and private insurers. 

Three new HCPCS codes included for 2010 are:
G0422    Intensive cardiac rehabilitation; with or without continuous ECG monitoring, with exercise, per hour, per session
G0423    Intensive cardiac rehabilitation; with or without continuous ECG monitoring, without exercise, per hour, per session
G0424    Pulmonary rehabilitation, including exercise (includes monitoring), per hour, per session

Cardiac rehabilitation services are currently reported using 93797 Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session), and 93798 Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session). Although no time element is defined, to CMS these codes represent sessions that are a minimum of 60 minutes’ duration. The agency believes this one-hour per session is the standard for cardiac rehabilitation exercise. The new HCPCS codes G0422–G0424 include this required time element. Codes 93797 and 93798 will continue to be used to report rehabilitation sessions that include aerobic exercises along with other exercises for each session. 

Effective for 2010, cardiac rehabilitation is covered by Medicare for up to 36 one-hour sessions, with a minimum of one session per week and a maximum of two sessions per day. Additional sessions up to 72 over an additional period of time may also be approved. Intensive cardiac rehabilitation services (ICR) programs include a series of 72 one-hour sessions, up to six sessions per day, over a period of 18 weeks.

Similar to the cardiac rehabilitation HCPCS codes, pulmonary rehabilitation (PR) will be reportable per hour session, covered up to 36 one-hour sessions with a maximum of two sessions per day, with the contractor having the discretion to approve up to 72 sessions. For pulmonary rehabilitation programs, effective January 1, hospitals should not report PR using G0244 rather than G0237, G0238, and G0239, which do not represent the full scope of services provided in a comprehensive pulmonary rehabilitation program.

CMS posted the final calendar year 2010 OPPS rule October 30, which included the new, deleted, and revised HCPCS codes.

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical/Technical Editor


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