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  • CMS Cardiac Rehab Policy Expands, Leaves Physical Therapy Coverage Unchanged

    The Centers for Medicare and Medicaid Services (CMS) finalized its policy decision to expand coverage of cardiac rehabilitation (CR) to patients with stable chronic heart failure (CHF) but made no significant changes to policies on physical therapy.

    In a decision memo issued February 18, CMS states that the evidence is sufficient to expand coverage for CR services to beneficiaries with stable CHF. "Stable" patients are defined as those who have not had recent major cardiovascular hospitalizations or procedures in the past 6 weeks, and those who have not had planned major cardiovascular hospitalizations or procedures in the past 6 months. The CMS definition of "chronic heart failure" includes left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.

    APTA supported access to rehabilitation for CHF patients but advocated for coverage of physical therapy for patients outside of the cardiac rehab benefit when medically necessary. The final decision memo does not address physical therapy provided outside of the CR program.

    As in the past, physical therapy will not be covered separately when provided as part of a cardiac rehabilitation exercise program, according to the National Coverage Determination for Cardiac Rehabilitation Programs. Physical therapy will remain covered when there is also a diagnosed noncardiac condition requiring such therapy—for example, when a patient who is recuperating from an acute phase of heart disease suffers a stroke requiring physical therapy for rehabilitation.

    APTA will post a summary of the final policy in the coming weeks.


    • Thank you for bringing this information to everyone about Cardiac Rehab for CHF.

      Posted by Sue McKinney, MSN, RN, FAACVPR on 7/28/2014 9:28 PM

    • I have chronic heart failure.Only 17% of my heart is working now.I am disabled on social security and medicare and Im low income.My wife is also disabled.I have a pacemaker/defibulator.My doctor has put me on Entresto but I cannot afford the $325 per month for this drug.My insurance Well care only pays $25 of this.Is there anything I can do to live longer or get this drug at a cheaper price.

      Posted by Frank Boyer on 4/2/2016 2:04 PM

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