NCD20.31 INTENSIVE CARDIAC REHABILITATION (ICR) PROGRAMS

 

 

Effective Date of this Version

10/25/2010

 

 

Benefit Category

 

• Intensive Cardiac Rehabilitation Program

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

 

Item/Service Description

 

• Intensive cardiac rehabilitation (ICR) refers to a physician-supervised program that furnishes cardiac rehabilitation services more frequently and often in a more rigorous manner.

• As required by §1861(eee) (4)(A) of the Social Security Act (the Act), an ICR program must show, in peer-reviewed published research, that it accomplished one or more of the following for its patients:

o Positively affected the progression of coronary heart disease.

o Reduced the need for coronary bypass surgery.

o Reduced the need for percutaneous coronary interventions.

• The ICR program must also demonstrate through peer-reviewed published research that it accomplished a statistically significant reduction in five or more of the following measures for patients from their levels before cardiac rehabilitation services to after cardiac rehabilitation services:

o Low density lipoprotein.

o Triglycerides.

o Body mass index.

o Systolic blood pressure.

o Diastolic blood pressure.

o The need for cholesterol, blood pressure, and diabetes medications.

• Individual ICR programs must be approved through the national coverage determination process to ensure that they demonstrate these accomplishments.

 

 

Indications and Limitations of Coverage

 

Coverage Transmittal Link

 

• http://www.cms.gov/transmittals/downloads/R125NCD.pdf

 

 

National Coverage Analyses (NCAs)

 

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Intensive Cardiac Rehabilitation (ICR) Program - Dr. Ornish's Program for Reversing Heart Disease (CAG-00419N) opens in new window

• Original consideration for Intensive Cardiac Rehabilitation (ICR) Program - Pritikin Program (CAG-00418N) opens in new window

 

 

Medicare NCD Link