Aetna · Clinical coverage policy

Aetna Cardiac Rehabilitation coverage criteria

Aetna covers medically supervised outpatient Phase II cardiac rehabilitation (up to 36 one-hour sessions over 36 weeks, with up to 36 more, not to exceed 72 total, after a new qualifying event) when a physician prescribes it within 12 months of a qualifying cardiac event such as MI, CABG, PCI, valve surgery, transplant, or stable chronic heart failure with LVEF <= 35%, provided the program meets all supervision and component requirements. Phase III/IV programs are not covered (deemed educational), cardiac rehab is not medically necessary after pericardiectomy for calcified constrictive pericarditis, and a long list of other indications (e.g., POTS, hypertrophic cardiomyopathy, post-ICD placement, post-stroke/TIA secondary prevention, uncontrolled arrhythmias) plus several active contraindications in CAD patients are considered experimental/investigational.

Policy CPB 0021 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0021

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0021 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Cardiac Rehabilitation (CPT 93797), and what gets it denied?

Path
Aetna covers medically supervised outpatient Phase II cardiac rehabilitation (up to 36 one-hour sessions over 36 weeks, with up to 36 more, not to exceed 72 total, after a new qualifying event) when a physician prescribes it within 12 months of a qualifying cardiac event such as MI, CABG, PCI, valve surgery, transplant, or stable chronic heart failure with LVEF <= 35%, provided the program meets all supervision and component requirements. Phase III/IV programs are not covered (deemed educational), cardiac rehab is not medically necessary after pericardiectomy for calcified constrictive pericarditis, and a long list of other indications (e.g., POTS, hypertrophic cardiomyopathy, post-ICD placement, post-stroke/TIA secondary prevention, uncontrolled arrhythmias) plus several active contraindications in CAD patients are considered experimental/investigational. Coverage criteria include: Aetna considers medically supervised outpatient Phase II cardiac rehabilitation medically necessary when individually prescribed by a physician within 12 months following ANY ONE of the qualifying events listed below.; Qualifying event: Acute myocardial infarction (MI) within the preceding 12 months.; Qualifying event: Chronic stable angina pectoris unresponsive to medical therapy that prevents optimal functioning, with modifiable coronary risk factors or poor exercise tolerance.; Qualifying event: Coronary artery bypass grafting (CABG).; Qualifying event: Great vessel surgery.; Qualifying event: Heart transplantation or heart-lung transplantation.; Qualifying event: Heart valve replacement or repair (sternotomy, transcatheter, or thoracotomy approach).; Qualifying event: Major pulmonary surgery.; Qualifying event: Open MAZE arrhythmia surgery.; Qualifying event: Percutaneous coronary intervention (PTCA, atherectomy, or stenting).; Qualifying event: Placement of a ventricular assist device (VAD).; Qualifying event: Removal of atrial myxoma.; Qualifying event: Stable chronic heart failure with left ventricular ejection fraction (LVEF) of 35% or less, New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks, AND no recent (<= 6 weeks) or planned (<= 6 months) major cardiovascular hospitalizations or procedures (meet ALL).; Qualifying event: Surgical septal myectomy via thoracotomy.; Qualifying event: Sustained ventricular tachycardia or fibrillation.; Qualifying event: Survivor of sudden cardiac death.; Qualifying event: Thoracic aortic aneurysm repair.; Program requirement (ALL of the following must be met): Physician-prescribed exercise each day cardiac rehabilitation items and services are furnished.; Program requirement: Provides up to a maximum of two 1-hour sessions per day for up to 36 sessions over a period of 36 weeks of medically supervised exercise, with or without continuous ECG monitoring (frequency generally consists of 2 to 3 sessions per week for 12 to 18 weeks).; Program requirement: Program is under the direct supervision of a physician or other qualified health care professional (NP or PA), who must be immediately available and accessible for medical consultations and emergencies at all times while services are furnished.; Program requirement: Direct supervision may include virtual presence through audio/video real-time communications technology (excluding audio-only) when telehealth criteria are met; hospital outpatient departments are NOT eligible for virtual telehealth services.; Program requirement: If not virtual, services are furnished in an onsite facility located in a physician's office or outpatient hospital setting with the necessary cardio-pulmonary, emergency, diagnostic, and therapeutic life-saving equipment immediately available.; Program requirement: An individual outpatient exercise program is created that can be self-monitored and maintained.; Program requirement: A psychosocial assessment is conducted.; Program requirement: Cardiac risk factor modification, including education, counseling, and behavioral intervention tailored to individual needs.; Program requirement: Outcomes assessment (objective clinical measures of exercise performance).; Telehealth/virtual supervision eligibility: Member must be LOW-RISK meeting ALL of the low-risk criteria AND have NONE of the listed exclusions.; Telehealth low-risk criterion (ALL required): LVEF > 50%.; Telehealth low-risk criterion: No complex arrhythmias at rest or with exercise.; Telehealth low-risk criterion: Uncomplicated MI, CABG, or percutaneous coronary intervention.; Telehealth low-risk criterion: Normal hemodynamic and ECG response.; Telehealth low-risk criterion: Asymptomatic with exercise.; Telehealth low-risk criterion: Functional capacity >= 7 METs (if measurable).; Telehealth low-risk criterion: Safe and supportive home environment with reliable internet for real-time audiovisual supervision.; Telehealth low-risk criterion: Ability to perform prescribed activities safely in the home.; Telehealth low-risk criterion: Understanding of exertion monitoring (heart rate targets).; Additional cardiac rehabilitation services are considered medically necessary when an eligible member has an additional qualifying event (ONE of): another cardiovascular surgery or percutaneous coronary intervention; OR another documented myocardial infarction or extension of the initial infarction; OR new clinically significant coronary lesions documented by cardiac catheterization.; For an additional qualifying event, up to an additional 36 sessions is considered medically necessary for continuation (not to exceed a total of 72 sessions).. Applies to 4 codes: 93797, 93798, G0422, G0423.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Phase III and Phase IV cardiac rehabilitation programs are NOT covered under standard Aetna benefit plans, as the programs do not require direct supervision by a physician or advanced practitioner (NP or PA) or continuous ECG monitoring; the programs are considered educational and training in nature, and education and training programs are generally not covered under most Aetna benefit plans.; Aetna considers cardiac rehabilitation NOT medically necessary for individuals following pericardiectomy for calcified constrictive pericarditis.; Experimental/investigational (contraindication-based) for coronary artery disease (CAD) patients with acute pericarditis or myocarditis.; Experimental/investigational for CAD patients with acute systemic illness or fever.; Experimental/investigational for CAD patients with clinical signs of decompensated aortic stenosis (angina, dyspnea on exertion, or syncope).; Experimental/investigational for CAD patients with forced expiratory volume < 1 liter.; Experimental/investigational for CAD patients with new-onset atrial fibrillation.; Experimental/investigational for CAD patients with progressive worsening of exercise tolerance or dyspnea at rest or on exertion over the prior 3 to 5 days.; Experimental/investigational for CAD patients with recent embolism or thrombophlebitis.; Experimental/investigational for CAD patients with third-degree heart block without a pacemaker.; Experimental/investigational for CAD patients with unstable angina.; Experimental/investigational (insufficient evidence) for atrial fibrillation or individuals who underwent AF ablation (other than open MAZE).; Experimental/investigational following balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.; Experimental/investigational following repair of sinus venosus atrial septal defect.; Experimental/investigational for individuals too debilitated to exercise.; Experimental/investigational for individuals with hypertrophic cardiomyopathy.; Experimental/investigational for individuals who underwent closure of patent foramen ovale.; Experimental/investigational for individuals who underwent placement of an implantable automated cardioverter-defibrillator.; Experimental/investigational for individuals with a history of high-degree atrioventricular block following permanent pacemaker implantation.; Experimental/investigational for individuals with Takotsubo (stress) cardiomyopathy.; Experimental/investigational for individuals with lymphoma undergoing autologous hematopoietic stem cell transplantation.; Experimental/investigational for postural tachycardia syndrome (POTS).; Experimental/investigational for prevention of chemotherapy-induced cardiotoxicity and/or improvement of fitness in individuals with subclinical markers of cardiotoxicity during chemotherapy.; Experimental/investigational for secondary prevention after stroke.; Experimental/investigational for secondary prevention after transient ischemic attack.; Experimental/investigational for uncompensated heart failure.; Experimental/investigational for uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion (member cannot have ANY of these): unstable angina or unstable heart failure.; Telehealth/virtual supervision exclusion: uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion: uncontrolled hypertension.; Telehealth/virtual supervision exclusion: inability to operate the technology or communicate effectively.; Telehealth/virtual supervision exclusion: cognitive impairment preventing safe participation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source: Aetna CPB 0021 — Cardiac Rehabilitation

Coverage criteria

  • Aetna considers medically supervised outpatient Phase II cardiac rehabilitation medically necessary when individually prescribed by a physician within 12 months following ANY ONE of the qualifying events listed below.
  • Qualifying event: Acute myocardial infarction (MI) within the preceding 12 months.
  • Qualifying event: Chronic stable angina pectoris unresponsive to medical therapy that prevents optimal functioning, with modifiable coronary risk factors or poor exercise tolerance.
  • Qualifying event: Coronary artery bypass grafting (CABG).
  • Qualifying event: Great vessel surgery.
  • Qualifying event: Heart transplantation or heart-lung transplantation.
  • Qualifying event: Heart valve replacement or repair (sternotomy, transcatheter, or thoracotomy approach).
  • Qualifying event: Major pulmonary surgery.
  • Qualifying event: Open MAZE arrhythmia surgery.
  • Qualifying event: Percutaneous coronary intervention (PTCA, atherectomy, or stenting).
  • Qualifying event: Placement of a ventricular assist device (VAD).
  • Qualifying event: Removal of atrial myxoma.
  • Qualifying event: Stable chronic heart failure with left ventricular ejection fraction (LVEF) of 35% or less, New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks, AND no recent (<= 6 weeks) or planned (<= 6 months) major cardiovascular hospitalizations or procedures (meet ALL).
  • Qualifying event: Surgical septal myectomy via thoracotomy.
  • Qualifying event: Sustained ventricular tachycardia or fibrillation.
  • Qualifying event: Survivor of sudden cardiac death.
  • Qualifying event: Thoracic aortic aneurysm repair.
  • Program requirement (ALL of the following must be met): Physician-prescribed exercise each day cardiac rehabilitation items and services are furnished.
  • Program requirement: Provides up to a maximum of two 1-hour sessions per day for up to 36 sessions over a period of 36 weeks of medically supervised exercise, with or without continuous ECG monitoring (frequency generally consists of 2 to 3 sessions per week for 12 to 18 weeks).
  • Program requirement: Program is under the direct supervision of a physician or other qualified health care professional (NP or PA), who must be immediately available and accessible for medical consultations and emergencies at all times while services are furnished.
  • Program requirement: Direct supervision may include virtual presence through audio/video real-time communications technology (excluding audio-only) when telehealth criteria are met; hospital outpatient departments are NOT eligible for virtual telehealth services.
  • Program requirement: If not virtual, services are furnished in an onsite facility located in a physician's office or outpatient hospital setting with the necessary cardio-pulmonary, emergency, diagnostic, and therapeutic life-saving equipment immediately available.
  • Program requirement: An individual outpatient exercise program is created that can be self-monitored and maintained.
  • Program requirement: A psychosocial assessment is conducted.
  • Program requirement: Cardiac risk factor modification, including education, counseling, and behavioral intervention tailored to individual needs.
  • Program requirement: Outcomes assessment (objective clinical measures of exercise performance).
  • Telehealth/virtual supervision eligibility: Member must be LOW-RISK meeting ALL of the low-risk criteria AND have NONE of the listed exclusions.
  • Telehealth low-risk criterion (ALL required): LVEF > 50%.
  • Telehealth low-risk criterion: No complex arrhythmias at rest or with exercise.
  • Telehealth low-risk criterion: Uncomplicated MI, CABG, or percutaneous coronary intervention.
  • Telehealth low-risk criterion: Normal hemodynamic and ECG response.
  • Telehealth low-risk criterion: Asymptomatic with exercise.
  • Telehealth low-risk criterion: Functional capacity >= 7 METs (if measurable).
  • Telehealth low-risk criterion: Safe and supportive home environment with reliable internet for real-time audiovisual supervision.
  • Telehealth low-risk criterion: Ability to perform prescribed activities safely in the home.
  • Telehealth low-risk criterion: Understanding of exertion monitoring (heart rate targets).
  • Additional cardiac rehabilitation services are considered medically necessary when an eligible member has an additional qualifying event (ONE of): another cardiovascular surgery or percutaneous coronary intervention; OR another documented myocardial infarction or extension of the initial infarction; OR new clinically significant coronary lesions documented by cardiac catheterization.
  • For an additional qualifying event, up to an additional 36 sessions is considered medically necessary for continuation (not to exceed a total of 72 sessions).

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Cardiac Rehabilitation (CPT 93797), and what gets it denied?
Aetna covers medically supervised outpatient Phase II cardiac rehabilitation (up to 36 one-hour sessions over 36 weeks, with up to 36 more, not to exceed 72 total, after a new qualifying event) when a physician prescribes it within 12 months of a qualifying cardiac event such as MI, CABG, PCI, valve surgery, transplant, or stable chronic heart failure with LVEF <= 35%, provided the program meets all supervision and component requirements. Phase III/IV programs are not covered (deemed educational), cardiac rehab is not medically necessary after pericardiectomy for calcified constrictive pericarditis, and a long list of other indications (e.g., POTS, hypertrophic cardiomyopathy, post-ICD placement, post-stroke/TIA secondary prevention, uncontrolled arrhythmias) plus several active contraindications in CAD patients are considered experimental/investigational. Coverage criteria include: Aetna considers medically supervised outpatient Phase II cardiac rehabilitation medically necessary when individually prescribed by a physician within 12 months following ANY ONE of the qualifying events listed below.; Qualifying event: Acute myocardial infarction (MI) within the preceding 12 months.; Qualifying event: Chronic stable angina pectoris unresponsive to medical therapy that prevents optimal functioning, with modifiable coronary risk factors or poor exercise tolerance.; Qualifying event: Coronary artery bypass grafting (CABG).; Qualifying event: Great vessel surgery.; Qualifying event: Heart transplantation or heart-lung transplantation.; Qualifying event: Heart valve replacement or repair (sternotomy, transcatheter, or thoracotomy approach).; Qualifying event: Major pulmonary surgery.; Qualifying event: Open MAZE arrhythmia surgery.; Qualifying event: Percutaneous coronary intervention (PTCA, atherectomy, or stenting).; Qualifying event: Placement of a ventricular assist device (VAD).; Qualifying event: Removal of atrial myxoma.; Qualifying event: Stable chronic heart failure with left ventricular ejection fraction (LVEF) of 35% or less, New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least 6 weeks, AND no recent (<= 6 weeks) or planned (<= 6 months) major cardiovascular hospitalizations or procedures (meet ALL).; Qualifying event: Surgical septal myectomy via thoracotomy.; Qualifying event: Sustained ventricular tachycardia or fibrillation.; Qualifying event: Survivor of sudden cardiac death.; Qualifying event: Thoracic aortic aneurysm repair.; Program requirement (ALL of the following must be met): Physician-prescribed exercise each day cardiac rehabilitation items and services are furnished.; Program requirement: Provides up to a maximum of two 1-hour sessions per day for up to 36 sessions over a period of 36 weeks of medically supervised exercise, with or without continuous ECG monitoring (frequency generally consists of 2 to 3 sessions per week for 12 to 18 weeks).; Program requirement: Program is under the direct supervision of a physician or other qualified health care professional (NP or PA), who must be immediately available and accessible for medical consultations and emergencies at all times while services are furnished.; Program requirement: Direct supervision may include virtual presence through audio/video real-time communications technology (excluding audio-only) when telehealth criteria are met; hospital outpatient departments are NOT eligible for virtual telehealth services.; Program requirement: If not virtual, services are furnished in an onsite facility located in a physician's office or outpatient hospital setting with the necessary cardio-pulmonary, emergency, diagnostic, and therapeutic life-saving equipment immediately available.; Program requirement: An individual outpatient exercise program is created that can be self-monitored and maintained.; Program requirement: A psychosocial assessment is conducted.; Program requirement: Cardiac risk factor modification, including education, counseling, and behavioral intervention tailored to individual needs.; Program requirement: Outcomes assessment (objective clinical measures of exercise performance).; Telehealth/virtual supervision eligibility: Member must be LOW-RISK meeting ALL of the low-risk criteria AND have NONE of the listed exclusions.; Telehealth low-risk criterion (ALL required): LVEF > 50%.; Telehealth low-risk criterion: No complex arrhythmias at rest or with exercise.; Telehealth low-risk criterion: Uncomplicated MI, CABG, or percutaneous coronary intervention.; Telehealth low-risk criterion: Normal hemodynamic and ECG response.; Telehealth low-risk criterion: Asymptomatic with exercise.; Telehealth low-risk criterion: Functional capacity >= 7 METs (if measurable).; Telehealth low-risk criterion: Safe and supportive home environment with reliable internet for real-time audiovisual supervision.; Telehealth low-risk criterion: Ability to perform prescribed activities safely in the home.; Telehealth low-risk criterion: Understanding of exertion monitoring (heart rate targets).; Additional cardiac rehabilitation services are considered medically necessary when an eligible member has an additional qualifying event (ONE of): another cardiovascular surgery or percutaneous coronary intervention; OR another documented myocardial infarction or extension of the initial infarction; OR new clinically significant coronary lesions documented by cardiac catheterization.; For an additional qualifying event, up to an additional 36 sessions is considered medically necessary for continuation (not to exceed a total of 72 sessions).. Applies to 4 codes: 93797, 93798, G0422, G0423. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Phase III and Phase IV cardiac rehabilitation programs are NOT covered under standard Aetna benefit plans, as the programs do not require direct supervision by a physician or advanced practitioner (NP or PA) or continuous ECG monitoring; the programs are considered educational and training in nature, and education and training programs are generally not covered under most Aetna benefit plans.; Aetna considers cardiac rehabilitation NOT medically necessary for individuals following pericardiectomy for calcified constrictive pericarditis.; Experimental/investigational (contraindication-based) for coronary artery disease (CAD) patients with acute pericarditis or myocarditis.; Experimental/investigational for CAD patients with acute systemic illness or fever.; Experimental/investigational for CAD patients with clinical signs of decompensated aortic stenosis (angina, dyspnea on exertion, or syncope).; Experimental/investigational for CAD patients with forced expiratory volume < 1 liter.; Experimental/investigational for CAD patients with new-onset atrial fibrillation.; Experimental/investigational for CAD patients with progressive worsening of exercise tolerance or dyspnea at rest or on exertion over the prior 3 to 5 days.; Experimental/investigational for CAD patients with recent embolism or thrombophlebitis.; Experimental/investigational for CAD patients with third-degree heart block without a pacemaker.; Experimental/investigational for CAD patients with unstable angina.; Experimental/investigational (insufficient evidence) for atrial fibrillation or individuals who underwent AF ablation (other than open MAZE).; Experimental/investigational following balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.; Experimental/investigational following repair of sinus venosus atrial septal defect.; Experimental/investigational for individuals too debilitated to exercise.; Experimental/investigational for individuals with hypertrophic cardiomyopathy.; Experimental/investigational for individuals who underwent closure of patent foramen ovale.; Experimental/investigational for individuals who underwent placement of an implantable automated cardioverter-defibrillator.; Experimental/investigational for individuals with a history of high-degree atrioventricular block following permanent pacemaker implantation.; Experimental/investigational for individuals with Takotsubo (stress) cardiomyopathy.; Experimental/investigational for individuals with lymphoma undergoing autologous hematopoietic stem cell transplantation.; Experimental/investigational for postural tachycardia syndrome (POTS).; Experimental/investigational for prevention of chemotherapy-induced cardiotoxicity and/or improvement of fitness in individuals with subclinical markers of cardiotoxicity during chemotherapy.; Experimental/investigational for secondary prevention after stroke.; Experimental/investigational for secondary prevention after transient ischemic attack.; Experimental/investigational for uncompensated heart failure.; Experimental/investigational for uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion (member cannot have ANY of these): unstable angina or unstable heart failure.; Telehealth/virtual supervision exclusion: uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion: uncontrolled hypertension.; Telehealth/virtual supervision exclusion: inability to operate the technology or communicate effectively.; Telehealth/virtual supervision exclusion: cognitive impairment preventing safe participation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.
Does Aetna require prior authorization for Cardiac Rehabilitation?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Cardiac Rehabilitation?
Policy exclusions and limitations: Phase III and Phase IV cardiac rehabilitation programs are NOT covered under standard Aetna benefit plans, as the programs do not require direct supervision by a physician or advanced practitioner (NP or PA) or continuous ECG monitoring; the programs are considered educational and training in nature, and education and training programs are generally not covered under most Aetna benefit plans.; Aetna considers cardiac rehabilitation NOT medically necessary for individuals following pericardiectomy for calcified constrictive pericarditis.; Experimental/investigational (contraindication-based) for coronary artery disease (CAD) patients with acute pericarditis or myocarditis.; Experimental/investigational for CAD patients with acute systemic illness or fever.; Experimental/investigational for CAD patients with clinical signs of decompensated aortic stenosis (angina, dyspnea on exertion, or syncope).; Experimental/investigational for CAD patients with forced expiratory volume < 1 liter.; Experimental/investigational for CAD patients with new-onset atrial fibrillation.; Experimental/investigational for CAD patients with progressive worsening of exercise tolerance or dyspnea at rest or on exertion over the prior 3 to 5 days.; Experimental/investigational for CAD patients with recent embolism or thrombophlebitis.; Experimental/investigational for CAD patients with third-degree heart block without a pacemaker.; Experimental/investigational for CAD patients with unstable angina.; Experimental/investigational (insufficient evidence) for atrial fibrillation or individuals who underwent AF ablation (other than open MAZE).; Experimental/investigational following balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension.; Experimental/investigational following repair of sinus venosus atrial septal defect.; Experimental/investigational for individuals too debilitated to exercise.; Experimental/investigational for individuals with hypertrophic cardiomyopathy.; Experimental/investigational for individuals who underwent closure of patent foramen ovale.; Experimental/investigational for individuals who underwent placement of an implantable automated cardioverter-defibrillator.; Experimental/investigational for individuals with a history of high-degree atrioventricular block following permanent pacemaker implantation.; Experimental/investigational for individuals with Takotsubo (stress) cardiomyopathy.; Experimental/investigational for individuals with lymphoma undergoing autologous hematopoietic stem cell transplantation.; Experimental/investigational for postural tachycardia syndrome (POTS).; Experimental/investigational for prevention of chemotherapy-induced cardiotoxicity and/or improvement of fitness in individuals with subclinical markers of cardiotoxicity during chemotherapy.; Experimental/investigational for secondary prevention after stroke.; Experimental/investigational for secondary prevention after transient ischemic attack.; Experimental/investigational for uncompensated heart failure.; Experimental/investigational for uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion (member cannot have ANY of these): unstable angina or unstable heart failure.; Telehealth/virtual supervision exclusion: uncontrolled arrhythmias.; Telehealth/virtual supervision exclusion: uncontrolled hypertension.; Telehealth/virtual supervision exclusion: inability to operate the technology or communicate effectively.; Telehealth/virtual supervision exclusion: cognitive impairment preventing safe participation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source

Aetna CPB 0021 — Cardiac Rehabilitation

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0021 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.