Cardiac and Pulmonary Rehab Billing Services
Cardiac and pulmonary rehab programs bill by the session, but the rules behind each session are strict. Medicare covers these programs only for specific conditions, caps the number of sessions, and expects physician oversight and a documented individual treatment plan. Missing any of those can put a whole series of claims at risk.
Most programs sit inside hospital outpatient departments, which means facility billing rules apply along with the program rules. Westmont connects rehab programs with vetted billing experts who know this setting. They help programs verify eligibility, track session counts, and keep documentation ready for review, so cardiac rehab billing and pulmonary rehab billing stay predictable for your team.
Who this is for
- Hospital outpatient cardiac rehabilitation programs
- Hospital outpatient pulmonary rehabilitation programs
- Physician-directed freestanding rehab programs
- Intensive cardiac rehab programs
- Cardiology and pulmonology practices that run in-office rehab
- Health systems expanding rehab to new locations
What gets billed
- Cardiac rehab sessions with ECG monitoring
- Cardiac rehab sessions without ECG monitoring
- Intensive cardiac rehab sessions
- Pulmonary rehab exercise sessions
- Physician services for pulmonary rehab oversight
- Initial program intake and assessment
- Individual treatment plan reviews
- Education and counseling that is part of the program
- Telehealth components, where a payer allows them
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 93797 | CPT | Cardiac rehab session without continuous ECG monitoring |
| 93798 | CPT | Cardiac rehab session with continuous ECG monitoring |
| G0422 | HCPCS | Medicare intensive cardiac rehab with exercise, per session |
| G0423 | HCPCS | Medicare intensive cardiac rehab without exercise, per session |
| G0424 | HCPCS | Medicare pulmonary rehab with exercise, per session |
| 94625 | CPT | Physician or qualified professional services for outpatient pulmonary rehab, without continuous oximetry |
| 94626 | CPT | Same services, with continuous oximetry |
| I25.10 | ICD-10-CM | Coronary artery disease without angina, native vessel |
| Z95.1 | ICD-10-CM | Presence of a coronary artery bypass graft |
| J44.9 | ICD-10-CM | Chronic obstructive pulmonary disease, unspecified |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in cardiac and pulmonary rehab
Qualifying conditions. Medicare covers cardiac rehab for specific events and conditions, and pulmonary rehab for certain chronic lung disease. Billers check that the diagnosis and the date of the qualifying event fit the policy.
Session limits. Medicare sets a maximum number of sessions over a time window, with more allowed only under certain conditions. Billers track counts to catch the point where more sessions need review.
Physician oversight. Programs generally need a physician involved in the program and available during sessions, and supervision rules have changed over time. Check current Medicare supervision guidance.
Individual treatment plans. Documentation must show a plan, regular physician review, and progress. Billers prompt clinicians to complete these before submission.
Choosing between code sets. CPT codes fit many commercial and standard programs, while Medicare uses HCPCS codes for intensive programs and pulmonary rehab. Billers choose by payer and program type.
Hospital outpatient claim rules. Facility claims use revenue codes and specific edits, and the physician component may be separate. Billers match claims to the hospital's setup.
Commercial authorization. Some plans require approval before rehab or limit visits by condition. Billers verify early and renew before limits are reached.
How Westmont can help
- Matching your program with vetted billing experts experienced in cardiac and pulmonary rehab billing
- End-to-end revenue cycle support, from eligibility to payment posting
- Denial management for session limit, diagnosis, and supervision issues
- Support for hospital outpatient claim workflows
- Tracking of session counts and treatment plan review dates
Frequently asked questions
Which conditions qualify for Medicare cardiac rehab?
Medicare generally covers cardiac rehab after events such as a recent heart attack, bypass surgery, certain valve procedures, stable angina, or heart failure meeting specific criteria. The exact list and timing rules are set by Medicare. Check current coverage policy and confirm the patient's qualifying event before the first session.
How many sessions does Medicare cover?
Medicare sets a maximum number of sessions for standard cardiac rehab over a set window, and a different cap for intensive programs. Pulmonary rehab also has limits, with additional sessions possible when medically necessary. Check current Medicare policy, since limits and extensions are subject to change.
What is the difference between 93797 and 93798?
Both are cardiac rehab session codes. 93798 includes continuous ECG monitoring, and 93797 does not. Medicare uses separate HCPCS codes for intensive programs. Choose the code that matches what was provided and what your payer accepts.
Does a physician have to be present for rehab sessions?
Medicare generally requires physician oversight and availability during sessions, and the definition of supervision has changed over time, including virtual options. Rules differ by payer. Confirm the current Medicare supervision requirements and your commercial contracts before relying on any arrangement.
Can a freestanding program bill for rehab?
Yes, often under physician office billing rules, though requirements for staffing, equipment, and emergency readiness apply. Billing differs from hospital outpatient programs. Tell us your setup and we will look for billing experts who know it.
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