33413 Insurance Policy Changes

Cardiac Rehabilitation: Outpatient (CPB 0021, reviewed 2026-03-10)

Aetna's updated Cardiac Rehabilitation: Outpatient policy (CPB 0021, effective 2026-03-10) establishes medical necessity criteria for Phase II cardiac rehabilitation, expands telehealth eligibility for low-risk members, and clarifies that up to 36 sessions are covered within 12 months of qualifying cardiac events, with an additional 36 sessions available upon subsequent qualifying events (maximum 72 total). The policy specifies direct physician/NP/PA supervision requirements, excludes Phase III/IV programs, and lists specific conditions where cardiac rehabilitation is considered experimental.