Cardiac rehabilitation uses CPT codes 93797 (physician supervision per session, without continuous ECG) and 93798 (with continuous ECG monitoring). Sessions are billed per visit, typically 3 times per week. Medicare covers 36 sessions over 36 weeks for qualifying diagnoses: acute MI, CABG, stable angina, PCI with stent, heart valve repair or replacement, or heart/heart-lung transplant. Intensive cardiac rehabilitation covers up to 72 sessions. Most commercial payers follow Medicare's model. Prior authorization is not required for Medicare qualifying diagnoses but should be verified with commercial payers. Sessions include supervised exercise, education, risk factor modification, and psychological support.
Bill 93797 for each supervised rehabilitation session without continuous ECG monitoring. Bill 93798 for sessions with continuous ECG (typically early post-MI or high-risk patients). Bill one code per session per day. Do not bill multiple codes for a single session. Use the qualifying cardiac diagnosis (I21.x for MI, I10 for hypertension management post-cardiac event, or other cardiac ICD-10) as the primary code. Document the patient's qualifying condition clearly on the claim. Sessions lasting less than 30 minutes do not qualify for billing.
Medicare automatically covers 36 sessions (36 weeks) for patients with qualifying diagnoses without prior auth. Intensive cardiac rehabilitation requires referral documentation from the treating cardiologist or physician but not formal prior auth. Most commercial payers require verification of benefits before enrollment. Some plans limit cardiac rehab to certain diagnoses or require prior auth. Document the qualifying diagnosis, post-procedure date (e.g., "10 days post-MI"), and treatment plan. Payers track attendance; missing more than 3 sessions may trigger review or early termination.
Cardiac rehab codes are not bundled with E/M or other cardiovascular procedures. Bill 93797 or 93798 as a separate service when the patient attends a rehab session. If the same provider delivers rehab supervision and also performs a separate E/M visit (patient check-in, medication adjustment) the same day, use modifier 25 on the E/M to indicate a distinct service. Do not use modifiers with 93797 or 93798. Each session is billed individually, not as a package.
Document the patient's qualifying cardiac diagnosis and post-procedure date. Record each session's date, duration, and type of activities (treadmill, bike, strength training, education topics). Document vital signs at session start and end (heart rate, blood pressure). Note exercise tolerance, any symptoms (chest pain, dyspnea, dizziness), medication adjustments, and patient compliance. Track weight, lipid panel results, and smoking status. For continuous ECG sessions, document the reason for ECG monitoring and any arrhythmias observed. Include progress notes showing functional improvement (increasing exercise tolerance, reducing symptoms, improved quality of life). Before discharge, summarize overall progress and long-term cardiovascular risk factor management plan.
Generally, no. Once a patient completes 36 sessions (or 72 for intensive), they are discharged. If the patient has a new cardiac event (second MI, new CABG), a new episode of care begins with a fresh 36-session authorization. Verify with the payer whether repeat enrollment is allowed for the same diagnosis within a 12-month period.
Cardiac rehabilitation (93797/93798) is a medically supervised program for patients with acute cardiac events or diagnoses requiring intensive monitoring. Cardiac wellness programs are preventive, ongoing programs for maintenance. Wellness programs do not bill rehabilitation codes; they are typically billed as gym memberships or health club fees, not medical codes.
No. Bill once per session regardless of duration (as long as the session is at least 30 min). The CPT code represents a single supervised session, not hours of service. Document the session duration in the note, but bill 93797 or 93798 only once per day per patient.
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