Non-Physician Practitioners Ordering CR-PR

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Attention All MAC J-15 AACVPR Members,

In January of 2016, both Cigna Medical Directors (Dr. Berman & Dr. Sandler) responded to  clarification over Non-Physician Practitioners (NPPs) referring to cardiac and pulmonary rehabilitation services.  They stated that Cigna has NO guidelines restricting NPPs from being the referring provider for Cardiac or Pulmonary Rehabilitation services. 

Most recently, CMS has reversed and clarified that MACs do not have the authority to determine whether non-physician practitioners (NP, PA, and CNS) may independently order CR/PR services. CMS interprets that it is bound by statutory language that categorizes CR and PR as “physician services”. This requires that an MD or DO must order Cardiac Rehabilitation services. Starting immediately, this means while NPPs may send a referral order to rehab to expedite the enrollment process, a physician would need to co-sign any referral order for these services.

If you have additional questions please contact me.

Richard Sukeena, MS, MBA, FAACVPR
AACVPR MAC Task Force J-15 Liaison

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