Page 234 - Medicare Benefit Policy Manual

As specified at 42 CFR 410.47(e), the number of PR sessions are limited to a maximum
of 2 1-hour sessions per day for up to 36 sessions over up to 36 weeks with the option for
an additional 36 sessions over an extended period of time if approved by the Medicare
Administrative Contractor (MAC).

PR Settings:

Medicare Part B pays for PR in a physician’s office or a hospital outpatient setting. All
settings must have the following: (i) A physician immediately available and accessible
for medical consultations and emergencies at all times when items and services are being
furnished under the program. This provision is satisfied if the physician meets the
requirements for direct supervision for physician office services, at 42 CFR 410.26, and
for hospital outpatient services at 42 CFR 410.27, and (ii) The necessary cardio-
pulmonary, emergency, diagnostic, and therapeutic life-saving equipment accepted by the
medical community as medically necessary (for example, oxygen, cardiopulmonary
resuscitation equipment, and defibrillator) to treat chronic respiratory disease.

PR Physician Standards:

Medical Director. Medical director means the physician who oversees the PR program at
a particular site. The medical director is the physician responsible for a PR program and,
in consultation with staff, is involved in directing the progress of individuals in the
program and must possess all of the following: (1) Expertise in the management of
individuals with respiratory pathophysiology. (2) Cardiopulmonary training in basic life
support or advanced cardiac life support. (3) Be licensed to practice medicine in the State
in which the PR program is offered.

Supervising Physician. Supervising physician means a physician that is immediately
available and accessible for medical consultations and medical emergencies at all times
items and services are being furnished to individuals under PR programs. Physicians
acting as the supervising physician must possess all of the following: (1) Expertise in the
management of individuals with respiratory pathophysiology. (2) Cardiopulmonary
training in basic life support or advanced cardiac life support. (3) Be licensed to practice
medicine in the State in which the PR program is offered.

(See Publication 100-04, Claims Processing Manual, chapter 32, section 140.4, for PR
claims processing, coding, and billing requirements.)

232 - Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation
(ICR) Services Furnished On or After January 1, 2010
(Rev. 11426; Issued: 05-20-22; Effective: 01-01-22; Implementation: 07-05-22)

Cardiac rehabilitation (CR) means a physician-supervised program that furnishes
physician prescribed exercise; cardiac risk factor modification, including education,
counseling, and behavioral intervention; psychosocial assessment; and outcomes
assessment. Intensive cardiac rehabilitation (ICR) program means a physician-supervised