CommercialCoverageMedium impact
Cardiac Rehabilitation 8.01.14
Excellus BlueCross BlueShield·Cardiology, Cardiothoracic Surgery, Physical Therapy·Therapy & Rehabilitation
Effective date
Oct 16, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their cardiac rehabilitation policy effective October 16, 2025, defining covered Phase I and Phase II programs for specific cardiac conditions while explicitly excluding Phase III maintenance programs and intensive cardiac rehabilitation programs as not medically necessary or investigational.
Action Required
By October 16, 2025: Billing team must verify cardiac rehabilitation claims meet covered criteria (acute MI, PCI, bypass surgery, heart transplant, Class II+ heart failure, stable angina, or valvular disease within 12 months). Stop billing for Phase III maintenance programs and intensive cardiac rehabilitation programs (Ornish, Pritikin, Benson-Henry programs) as these will be denied. Ensure Phase II programs have physician supervision and continuous EKG monitoring documented.