Who qualifies for intensive cardiac rehab?
A patient is eligible for Medicare‑covered Intensive Cardiac Rehabilitation (ICR) if they have at least one of the following:
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Acute Myocardial Infarction (MI) - Heart attack
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Occurred within the preceding 12 months.
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Coronary Artery Bypass Graft (CABG) Surgery
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Current Stable Angina Pectoris
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Heart Valve Repair or Replacement
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Surgical or transcatheter.
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Percutaneous Coronary Intervention (PCI)
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Includes angioplasty and/or coronary stent placement
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Heart or Heart–Lung Transplant
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Medicare now covers CR/ICR for stable chronic heart failure (CHF) when ALL of the following are met:
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Left Ventricular Ejection Fraction (LVEF) ≤ 35%
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NYHA Class II–IV
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Being treated with medication
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Clinically stable
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Qualifying Diagnosis Code:
Acute MI
I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4,
I20.B, I22.0, I22.1, I22.2, I22.8, I22.9, 124.81, I24.89, I25.2*, I25.6, I5A
CABG
Z95.1, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792,
I25.85, I25.81-I25.812, Z48.812
Stable Angina
I20.1, I20.2, I20.81, I20.89, I20.9, I25.112, I25.118
Valve Repair/Replacement
Z95.2–Z95.5, Z48.812
PCI
Z95.5, Z98.61, Z48.812
Heart/Heart‑Lung Transplant
Z48.21, Z48.280, Z94.1, Z94.3, Z95.1
Chronic Heart Failure
I50.22, I50.42, I50.82, I50.84, I50.89
*Must have happened at least 4wks prior to start of ICR - I25.2*
