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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.17 Cardiac Rehabilitation : 9.2.17.1 Prior Authorization for Cardiac Rehabilitation

9.2.17.1
Prior authorization is not required for the initial 36 sessions of cardiac rehabilitation.
Cardiac rehabilitation may be considered medically necessary beyond 36 sessions in the following circumstances:
Requests for prior authorization for additional sessions that exceed a total of 36 sessions in 52 weeks will not be granted. Prior authorization must be obtained through the TMHP Special Medical Prior Authorization (SMPA) Department.

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