Outpatient cardiac rehabilitation programs may be considered medically necessary for individuals with a history of the following conditions and procedures:
· acute myocardial infarction (heart attack) within the preceding 12 months;
· coronary artery bypass graft surgery;
· percutaneous transluminal coronary angioplasty or coronary stenting;
· heart valve surgery;
· heart or heart-lung transplantation;
· current stable angina pectoris; or
· compensated heart failure.
Repeat participation in an outpatient cardiac rehabilitation program in the absence of another qualifying cardiac event is considered investigational.
Intensive cardiac rehabilitation with the Ornish Program for Reversing Heart Disease, Pritikin Program, or Benson-Henry Institute Program is considered investigational.
Virtual cardiac rehabilitation is considered investigational.
