Billing Cardiac Rehabilitation Session and Session Limitations

CR sessions are limited to a maximum of two one-hour sessions per day for up to 36 sessions up to 36 weeks with the option of an additional 36 sessions over an extended period, if approved by the contractor under section 1862(a)(1)(A) of the Act. Sessions billed beyond the 36 sessions should be billed with the KX modifier if the services are medically necessary and meet all the Medicare Program requirements. CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Section 140.2.2.4, Edits for CR Services Exceeding 36 Sessions states, 

“Effective for claims with dates of service on or after 1/1/2010, contractors shall deny all claims with HCPCS 93797 and 93798 (both professional and institutional claims) that exceed 36 CR sessions when a KX modifier is not included on the claim line.”

CR session limitations are based on medically necessary events and not a lifetime limitation. Therefore, if a beneficiary has completed 72 sessions of cardiac rehabilitation and then has a new qualifying event they would be entitled to CR as long as all other program requirements are met.

Revised 9/5/2024