CMS Expands Coverage of Cardiac Rehab for Heart Failure Patients

CMS has decided to expand Medicare coverage for cardiac rehabilitation services.

According to a decision memo, hospitals and other providers will now receive payment for cardiac rehab services for Medicare beneficiaries with "stable, chronic heart failure." CMS defined "stable" patients as those who have not had recent or planned major cardiovascular hospitalizations or procedures.

Further, those CHF patients must have "left ventricular ejection fraction of 35 percent or less" and specific symptoms within the New York Heart Association's functional classification system.

Previously, CMS only reimbursed providers for cardiac rehab services for Medicare beneficiaries who had a heart attack in the preceding 12 months, a coronary artery bypass surgery and four other specific scenarios. Cardiac rehab for stable patients with chronic heart failure was not covered because CMS said there was not enough evidence proving the services improved health outcomes.

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