September 10, 2020
Control Number: 81-14
Subject: Cardiac Rehabilitation Programs in Outpatient Hospital Settings
References: Amended 1950 & 1974 Benefit Plans & Trusts,
Article III, Sections A (2) (c) and A (3) (j) and (o) 4
Question:
Are benefits provided if cardiac rehabilitation programs are conducted on an outpatient hospital basis?
Answer:
Yes. Benefits are provided for such programs if conducted in an outpatient hospital setting. This includes coverage for stress testing, other medically necessary tests and associated therapy performed as part of the rehabilitation program. However, benefits are only provided for those parts of the program that are conducted under a physician’s direct supervision.