When you have a heart condition, a doctor-supervised rehabilitation program, tailored to your individual needs, can help get your heart back into shape, reduce your risk factors and improve the quality of your life.
Medicare will cover a cardiac rehabilitation program if you have had any of the following illnesses:
- Had a heart attack in the last 12 months;
- Had coronary bypass surgery;
- Stable angina pectoris (chest pain or discomfort due to heart disease);
- Had a heart valve repair or heart valve replacement;
- Had a percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting—which widens an artery so blood can pass through more easily; and/or
- Had a heart or combined heart-lung transplant.
Depending upon your needs, your doctor will either prescribe a general or intensive cardiac rehabilitation program.
In addition, you must:
- Have your doctor prescribe the program for you;
- Get services under the supervision of a doctor at the outpatient department of a hospital or in a doctor’s office ; and
- Take part in a comprehensive program that includes:
- Physician prescribed exercises for each cardiac rehabilitation visit
- A program to modify cardiac risk factors (such as nutritional counseling and education)
- Assessment of outcomes
- Psychosocial assessment to look at an individual’s mental and emotional needs that affect their rehabilitation.
- Individualized treatment plan
Medicare will pay for up to two one-hour long sessions per day for up to 36 sessions over 36 weeks. If medically necessary, Medicare will cover an additional 36 sessions. If you qualify for intensive rehabilitation services, Medicare will pay for up to six one-hour long sessions per day for up to 72 sessions over 18 weeks.
If you receive the services, in a doctor’s office, Medicare will pay 80 percent of the Medicare-approved amount after you have paid the Part B deductible. If you receive the services in a hospital outpatient department, you will pay a copayment that can be no more than the Part A hospital deductible ($1,288 in 2016).