Page 236 - Medicare Benefit Policy Manual

staff must be considered by the physician in developing and/or reviewing individualized
treatment plans. (ii) Objective clinical measures of exercise performance and self-
reported measures of exertion and behavior.

Individualized treatment plan. Individualized treatment plan means a written plan tailored
to each individual patient that includes all of the following: (i) A description of the
individual’s diagnosis. (ii) The type, amount, frequency, and duration of the items and
services furnished under the plan. (iii) The goals set for the individual under the plan. The
individualized treatment plan detailing how components are utilized for each patient,
must be established, reviewed, and signed by a physician every 30 days.

As specified at 42 CFR 410.49(f)(1), the number of CR 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).

As specified at 42 CFR 410.49(f)(2), ICR sessions are limited to 72 1-hour sessions (as
defined in section 1848(b)(5) of the Act), up to 6 sessions per day, over a period of up to
18 weeks.

CR and ICR Settings:

Medicare Part B pays for CR and ICR in a physician’s office or a hospital outpatient
setting. All settings must have 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.

Standards for an ICR Program:

To be approved as an ICR program, a program must demonstrate through peer-reviewed,
published research that it has accomplished one or more of the following for its patients:
(i) Positively affected the progression of coronary heart disease. (ii) Reduced the need for
coronary bypass surgery. (iii) Reduced the need for percutaneous coronary interventions.

An ICR program must also demonstrate through peer-reviewed published research that it
accomplished a statistically significant reduction in 5 or more of the following measures
for patients from their levels before CR services to after CR services: (i) Low density
lipoprotein. (ii) Triglycerides. (iii) Body mass index. (iv) Systolic blood pressure. (v)
Diastolic blood pressure. (vi) The need for cholesterol, blood pressure, and diabetes
medications.

A list of approved ICR programs, identified through the NCD process, will be listed in
the Federal Register and is available on the CMS website at
https://www.cms.gov/Medicare/Medicare-General-