AACVPR REIMBURSEMENT UPDATE
FEBRUARY 8, 2008
CMS CARDIAC REHABILITATION BILLING CLARIFICATION
At the request of AACVPR, the Centers for Medicare and Medicaid Services (CMS) has published clarification of Transmittal 1417, “CR Instructions on Multiple Billing," which discussed a time requirement for cardiac rehabilitation. Click here to view the previous AACVPR Reimbursement Update.
The following is posted on the CMS Questions web page at: http://www.cms.hhs.gov/HospitalOutpatientPPS/Downloads/CardiacRehabilitation_0201208.pdf
January 29, 2008
Reporting of Cardiac Rehabilitation
Questions and Answers
Q1: Must one session of CPT code 93798 (Physician services for cardiac rehabilitation, with continuous ECG monitoring (per session)) be a minimum of 60 minutes if only one session is provided that day?
A1: No, if a hospital provides and bills for only one session of cardiac rehabilitation services (using either CPT code 93797 or CPT code 93798) for a patient in a given day; that session does not have to be a minimum of 60 minutes. However, because Medicare only covers a limited number of sessions for a beneficiary according to national coverage policy, we expect that hospitals will carefully plan a Medicare beneficiary’s cardiac rehabilitation so that the patient receives the anticipated benefit from the services.
Q2: If a hospital bills for three sessions of cardiac rehabilitation services for a patient on a given day, must they each be a minimum of 60 minutes?
A2: As stated in Transmittal 1417/ CR 5912, in order to report more than one session for a given date of service, each session must last a minimum of 60 minutes. For example, if the services provided on a given day total 1 hour and 50 minutes, then only one session should be billed to report the cardiac rehabilitation services provided on that day. Because Medicare only covers a limited number of sessions for a beneficiary according to national coverage policy, we expect that hospitals will carefully plan a Medicare beneficiary’s cardiac rehabilitation so that the patient receives the anticipated benefit from the services.
Karen Lui, R.N., M.S.
(FL phn) 239-768-6412
(DC phn) 703-752-4353
Karen@GRQConsulting.com |
