Reimbursement

Reimbursement

CR CPT Code Definitions

CPT Code 93797

  • Physician services for outpatient CR without continuous ECG monitoring (per session)

CPT Code 93798

  • Physician services for outpatient CR with continuous ECG monitoring (per session)

 

CR Coding & Billing

Exercise

CR (93797 or 93798): Patient must have some exercise every day, but is not required every session

Session duration

One session must be at least 31 minutes in duration

Two sessions must be at least 91 minutes in duration if billing for two sessions

*Document time in and time out!

*CMS does not require certain # of minutes of EXERCISE!

CR Billing & Coding

Time limit

36 weeks to complete up to 36 sessions

CMS does not require a weekly # of sessions

KX modifier

Must be used for any CR sessions beyond the first 36 in a patient’s Medicare lifetime

 

Medicare Proposed Hospital Outpatient Payment Rates for 2019

OPPS=Outpatient Prospective Payment System

Service Procedure code APC Payment Co-pay

  • CR 93798 & 9397 5771 118.79 23.76
  • ICR G0422-23 5771 118.79 23.76
  • PR G0424 5733 56.60 11.32
  • Resp Care G0237-39 5732 32.89 6.58
  • SET PAD 93668 5733 56.60 11.32

Medicare Proposed Physician Fee Schedule (PFS) Payment Rates for 2019

Medicare payment rates for physician practices are calculated using formula that considers

  • Physician work (Relative Value Units or RVUs)
  • Malpractice RVUs
  • Practice expense RVUs
  • Conversion factor

Medicare payment rates for nonexcepted hospital outpt services will be 40% of OPPS payment rates same as 2018

CR $45.00

PR  $22.00

SET  $22.00

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