Cardiac rehabilitation may be considered medically necessary beyond 36 sessions in the following circumstances:
• The prescribing physician documents that a continuation of cardiac rehabilitation is medically necessary. Documentation must include the following:
• Progress made from the beginning of cardiac rehabilitation period to the current service request date, including progress towards previous goals.
• A proposed treatment plan for the requested extension dates with specific goals related to the client’s individual needs.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.
Texas Medicaid & Healthcare Partnership |
CPT only copyright 2014 American Medical Association. All rights reserved. |