1. What is “virtual” delivery of cardiac rehab?
Virtual cardiac rehab (CR) refers to synchronous CR delivered with real-time audiovisual communication technology to facilitate patient and clinician interaction during an exercise session.
2. What is “remote” delivery of cardiac rehab?
Remote cardiac rehab (CR) refers to CR delivered with asynchronous activities without real-time communication between patients and clinicians at the time of an exercise session.
3. What is “hybrid” delivery of cardiac rehab?
Hybrid cardiac rehab refers to a mixture of synchronous center-based sessions, virtual sessions and remote sessions delivered to meet the individual needs of the patient.
4. Can we bill for virtual and remote sessions?
Virtual sessions can be delivered and reimbursed during the Public Health Emergency (PHE) using the Hospital Without Walls waivers. This has been possible through the Hospitals Without Walls waivers that were put into effect in March of 2020 in response to the PHE. These waivers will expire at the conclusion of the PHE. This means virtual delivery will no longer be an option for hospital outpatient CR programs after the PHE ends.
For virtual delivery of CR the same conditions of coverage (for center-based CR) must be met, including:
· Clinical indications, required education and exercise program components, exercise requirements, session duration requirements, and physician supervision of the services
· MD/DO referral order is obtained prior to enrollment
· Initial assessment, psychological assessment, outcomes assessment
· Individualized treatment plan (ITP) every 30 days, reviewed and signed by a physician
Remote CR sessions are not billable.
5. What code do we bill for virtual CR?
93797 (if no continuous ECG monitoring) 93798 (with continuous ECG monitoring). A PO modifier will need to be added to the CPT code.
6. Is the reimbursement less for virtual CR?
No, the reimbursement is the same as if the patient participated in a center-based program.
7. Does the patient need to be at their home to receive a “virtual” CR session?
No, the patient may have their session outside their home, i.e. community center.
8. Can the clinical staff deliver the virtual session to the patient outside of their CR department or hospital?
CMS remains silent on where the provider needs to be. The supervising physician must be immediately accessible and available while the clinical staff is hosting the session. This virtual option of physician supervision is temporarily extended and will remain in effect through the end of the calendar year in which the PHE ends. Because the PHE is currently extended to January 16, 2022 (and perhaps beyond that date), this means virtual direct supervision will be in place at least until December 31, 2022.