Medicare Coverage of Cardiac Rehabilitation
What It Is
Rehabilitation therapy for heart attack patients and others with cardiac conditions, provided on an outpatient basis
Medicare Part B covers physician-prescribed rehabilitation programs for patients with certain heart conditions. The programs can include exercise (both individual and group classes), education, and counseling for patients who have, or have had, any of the following:
A heart attack in the previous 12 months
Coronary bypass surgery
Stable angina pectoris
Heart valve repair/replacement
Angioplasty or coronary stenting
A heart or heart-lung transplant
These programs are provided by a hospital outpatient department or by outpatient clinics, and there's usually a limit of 36 rehabilitation sessions.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for cardiac rehabilitation, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for covered cardiac rehabilitation.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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