intensive cardiac rehabilitation program

(4) (A) The term “intensive cardiac rehabilitation program” means a physician-supervised program (as described in paragraph (2)) that furnishes the items and services described in paragraph (3) and has shown, in peer-reviewed published research, that it accomplished— (i) one or more of the following: (I) positively affected the progression of coronary heart disease; or (II) reduced the need for coronary bypass surgery; or (III) reduced the need for percutaneous coronary interventions; and (ii) a statistically significant reduction in 5 or more of the following measures from their level before receipt of cardiac rehabilitation services to their level after receipt of such services: (I) low density lipoprotein; (II) triglycerides; (III) body mass index; (IV) systolic blood pressure; (V) diastolic blood pressure; or (VI) the need for cholesterol, blood pressure, and diabetes medications. (B) To be eligible for an intensive cardiac rehabilitation program, an individual must have— (i) had an acute myocardial infarction within the preceding 12 months; (ii) had coronary bypass surgery; (iii) stable angina pectoris; (iv) had heart valve repair or replacement; (v) had percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting; (vi) had a heart or heart-lung transplant; (vii) stable, chronic heart failure (defined as patients with left ventricular ejection fraction of 35 percent 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); or (viii) any additional condition for which the Secretary has determined that a cardiac rehabilitation program shall be covered, unless the Secretary determines, using the same process used to determine that the condition is covered for a cardiac rehabilitation program, that such coverage is not supported by the clinical evidence. (C) An intensive cardiac rehabilitation program may be provided in a series of 72 one-hour sessions (as defined in section 1395w–4(b)(5) of this title ), up to 6 sessions per day, over a period of up to 18 weeks.


42 USC § 1395x(eee)(4)

Scoping language

For purposes of this subchapter
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