CommercialPrior AuthMedium impact
Cardiac Rehabilitation in the Outpatient Setting
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, PM&R (Physical Medicine & Rehab)·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their cardiac rehabilitation policy defining Phase II outpatient cardiac rehab coverage with specific qualifying diagnoses, contraindications, and visit limits based on risk stratification (12 visits for low risk, 24 for moderate risk, 36 for high risk). Programs must be AACVPR certified and prior approval is required for fully insured and most self-insured groups.
Action Required
Immediately: Billing team must verify cardiac rehabilitation programs are AACVPR certified before scheduling patients. Obtain prior authorization for all fully insured and most self-insured BCBS Mississippi groups before starting Phase II cardiac rehab. Update patient eligibility verification to confirm qualifying cardiovascular diagnoses and ensure no contraindications exist. Set visit limits in billing system: 12 visits for low risk, 24 for moderate risk, 36 for high risk patients.