The Centers for Medicare and Medicaid Services (CMS) has finalized its policy decision to expand coverage of cardiac rehabilitation (CR) to patients with stable chronic heart failure (CHF), but no significant changes were made to policies on physical therapy. According to a news release from the American Physical Therapy Association (APTA), a CMS decision memo issued February 18 states that the evidence is sufficient to expand coverage for CR services to beneficiaries with stable CHF.
The APTA news release notes that “stable” patients are defined as patients who had not had recent major cardiovascular hospitalizations or procedures in the past 6 weeks and those who have not had planned major cardiovascular hospitalizations or procedures in the past 6 months. The CMS definition of “chronic heart failure” includes left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.
As indicated on the APTA news release, the final decision memo from CMS does not address physical therapy provided outside of the CR program. Physical therapy will not be covered separately when provided as part of a cardiac rehabilitation program, which is according to the National Coverage Determination for Cardiac Rehabilitation Programs. Physical therapy will remain covered when there is also a diagnosed non-cardiac condition requiring such therapy.
The association news release notes that APTA will post a summary of the final policy in the coming weeks.