Editor's Note: Since this article was originally published in July 2021, the Center for Medicare & Medicaid Services (CMS) has announced that virtual CR and ICR services will continue being reimbursed through December 31, 2023 at the same rate as facility-based rehab.  For reimbursement specifics, please refer to page 155 of the CMS Final Rule, as well as the “Telehealth Services under the PFS” section of the CMS fact sheet.


During the Covid-19 lockdown, many cardiac rehab programs were forced to close their programs. Others severely reduced their capacity due to social-distancing restrictions and clinical staff reassignments. This necessitated the acceleration of a trend that was already underway: the provision of Home-Based Cardiac Rehab (HBCR), also known as Virtual Cardiac Rehab (VCR).

An Early Look at the Benefits of a Virtual Offering

A small number of healthcare providers pioneered HBCR and had been utilizing it for several years. Remarkably, the results were comparable to those of facility-based programs. HBCR offered:

  • Services to patients who lived too far away to regularly attend onsite.
  • Services to patients who lacked transportation.
  • A convenient delivery model to increase the number of rehab sessions completed.

Addressing an Immediate Need Accelerates Reimbursement

A major impediment to the widespread use of HBCR was a lack of available reimbursement, especially for Medicare recipients. In 2018, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) formed a committee to explore HBCR and develop recommendations and guidelines, as well as develop a strategy to make the service reimbursable by CMS. However, the lockdowns associated with Covid-19 made the need for remote CR immediate, and CMS policy quickly evolved to provide a temporary payment mechanism for Medicare recipients.

Under the "Hospitals Without Walls" waiver put forth by CMS, HBCR that was provided virtually, with real-time two-way audio/visual communication, was approved for reimbursement through the hospital outpatient prospective payment system (OPPS) rate for the duration of the Public Health Emergency (PHE). This November, CMS is expected to announce its policy beyond 2021.

Well-Positioned for the Future

In the meantime, the PHE has provided many cardiac rehab programs an opportunity to offer VCR to patients in a financially viable manner. These programs have also been able to use this window as a “learning opportunity” to be well-positioned to continue and expand their virtual programs if/when CMS approves ongoing coverage. They have also been able to assess how a hybrid model – combining both in-person and virtual delivery – could work both operationally and financially should CMS change its current coverage criteria.

The need to shift from an on-site delivery format to a virtual one has been an accelerated journey for cardiac rehab program across the country. If your facility isn’t already vetting virtual cardiac rehab, now is the time! Pritikin ICR can provide you with information and guidance to assess this unique opportunity for your patients and program.