However, effective with dates of service January 1, 2008 or later, hospitals may report more than one unit of HCPCS codes 93797 or 93798 for a date of service if more than one cardiac rehabilitation session lasting at least 1 hour each is provided on the same day.
Full Answer
What is the difference between 93797 and 93798?
93797 – Physician services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session); and 93798 – Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session).
What is a 93798 cardiologist?
93798 – Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session).
When do the new CPT codes go into effect?
Unless otherwise noted, the provisions go into effect on Jan. 1, 2022. CMS will extend Category 3 services until the end of CY 2023 to provide more time to collect data. CMS also added Current Procedural Terminology (CPT) codes 93797 and 93798, and Healthcare Common Procedure Coding System (HCPCS) codes G0422 and G0423 to the list.
What is the CPT code for continuous ECG monitoring?
When billing CPT code 93798, the documentation must clearly indicate the patient is receiving continuous ECG monitoring. A cardiac rehabilitation record must be maintained. All components, including ECG strips, must be maintained.
Does Medicare cover CPT code 93798?
Medicare coverage of cardiac rehabilitation services is defined in the Code of Federal Regulations (42 CFR 410.49). Coverage for cardiac rehabilitation services is limited to patients with one or more of the following: Acute myocardial infarction within the preceding 12 months; or. Coronary artery bypass surgery; or.
How often can CPT 93798 be billed?
If you have questions regarding the information contained in this update, contact your Provider Relations representative or call 1-877-658-0305. When billing CPT-4 codes 93797 and 93798, there is a maximum of two one-hour sessions per day and up to a maximum of 24 one-hour sessions over a 24-week period.
What is the revenue code for cardiac rehab?
Group 1CodeDescription93797PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING (PER SESSION)1 more row
Are CPT codes updated annually by CMS?
We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain DHS categories or that may qualify for certain exceptions.
Can you bill G0422 and G0423 together?
No more than two one-hour sessions, utilizing any combination of the CPT® or HCPCS codes (93798, 93797 or G0422, G0423) will be allowed per day for up to 36 sessions over a maximum of 36 weeks (Phase IIA).
What is Cardiac Rehabilitation Programme?
Cardiac rehabilitation, also called cardiac rehab, is a customized outpatient program of exercise and education. The program is designed to help you improve your health and recover from a heart attack, other forms of heart disease or surgery to treat heart disease.
When Should revenue code 636 be used?
Managed care payers often have “carve-out” payments for drugs reported in revenue code 636 (Drugs requiring detailed coding) when reported on both inpatient and outpatient claims. Outlier payments are calculated on all charges reported for inpatients and outpatients.
Does rev code 270 require HCPCS?
Only the revenue codes listed below are recognized on the outpatient hospital claim as facility revenue codes. Do not list both a facility code and a CPT/HCPCS code. * Revenue code 270 should be reported only once on the outpatient claim. It is to be reported for medical or surgical supplies or both combined.
What is revenue code 942?
942. Other Therapeutic - Cardiac Rehab.
How often are HCPCS codes updated?
quarterlyThe complete HCPCS file is updated and released quarterly to the Medicare contractors. The file contains existing, new, revised and discontinued HCPCS codes for the October 2021 quarter. Contractors must download the file via the CMS mainframe in September 2021.
When Must new CPT codes be used Is there a grace period?
Since HCPCS codes are updated annually every January 1, the grace period for billing discontinued HCPCS codes was implemented every January 1 through March 31.
How often are medical codes updated?
annuallyAs the designated standard for the electronic reporting of physician and other health care professional services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), CPT codes are updated annually and effective for use on Jan. 1 of each year.
What is the CPT time rule?
The CPT midpoint rule, which says that “a unit of time is attained when the midpoint is passed,” applies to codes that specify a time basis for code selection. Though not accepted by all payers, even Medicare allows the midpoint rule for some services.
Can you bill multiple units of 97140?
The qualified professional (See definition in Pub. 100-02/15, section 220) shall select one appropriate CPT code (97112, 97110, 97140) to bill since each unit was performed for the same amount of time and only one unit is allowed.
How many units can you bill Medicare?
That's where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes....Minutes and Billing Units.8 – 22 minutes1 unit23 – 37 minutes2 units38 – 52 minutes3 units53 – 67 minutes4 units68 – 82 minutes5 units1 more row•Sep 13, 2018
Is ultrasound a time-based code?
For example, types of time-based CPT codes include: Manual therapy (97140), Ultrasound (97035), Therapeutic exercises (97110), and.
How many sessions per week for cardiac rehabilitation?
Patients generally receive 2 to 3 sessions per week for 12 to 18 weeks. The contractor has discretion to cover cardiac rehabilitation services beyond 18 weeks. Coverage must not exceed a total of 72 sessions for 36 weeks.
How many sessions of cardiac rehabilitation are required?
Effective for dates of services on or after March 22, 2006, services provided in connection with a cardiac rehabilitation exercise program may be considered reasonable and necessary for up to 36 sessions. Patients generally receive 2 to 3 sessions per week for 12 to 18 weeks.
Does Medicare cover cardiac rehabilitation?
Medicare covers cardiac rehabilitation exercise programs for patients who meet the following criteria: • Have had a heart or heart-lung transplant. Effective for dates of services on or after March 22, 2006, services provided in connection with a cardiac rehabilitation exercise program may be considered reasonable and necessary for up ...
What is the HCPCS level?
The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS. Level I of the HCPCS is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA).
When is the HCPCS 2021 deadline?
The deadline for submission of new HCPCS code applications for 2021 1 st quarterly cycle for Drugs and Biologicals is January 4, 2021. The deadline for submission of new HCPCS code applications for 2021 1 st bi-annual cycle for DMEPOS and Other Non-Drug, Non-Biological Coding Cycles is January 4, 2021. The deadline for submission of new HCPCS code ...
What is level 2 of HCPCS?
Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.
When was level 2 of HCPCS developed?
The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits.
What is the purpose of CPT?
These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA.
