CR CPT Code Definitions
CPT Code 93797
- Physician services for outpatient CR without continuous ECG monitoring (per session)
CPT Code 93798
- Physician services for outpatient CR with continuous ECG monitoring (per session)
CR Coding & Billing
Exercise
CR (93797 or 93798): Patient must have some exercise at every session, but does not need to exercise within each billing code when using both
Session duration
One session must be at least 31 minutes in duration
Two sessions must be at least 91 minutes in duration if billing for two sessions
*Document time in and time out!
*CMS does not require certain # of minutes of EXERCISE!
CR Billing & Coding
Time limit
36 weeks to complete up to 36 sessions
CMS does not require a weekly # of sessions
KX modifier
Must be used for any CR sessions beyond the first 36 in a patient’s Medicare lifetime
PR CPT Code Definitions
CPT Code 94625
- Outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)
CPT Code 94626
- Outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session)
PR Coding & Billing
Exercise
PR (94625 or 94626): Patient must have some exercise at every session, but does not need to exercise within each billing code when using both
Session duration
One session must be at least 31 minutes in duration
Two sessions must be at least 91 minutes in duration if billing for two sessions
*Document time in and time out!
*CMS does not require certain # of minutes of EXERCISE!
PR Billing & Coding
Time limit
There is no window of time within which a patient must complete an up-to-36 session PR course
Lifetime limit of 72 sessions
CMS does not require a weekly number of sessions
KX modifier
Must be used for any PR sessions beyond the first 36 in a patient’s Medicare lifetime
Respiratory Therapy Services Codes Definition
G0237
- Therapeutic procedures to increase strength and endurance of respiratory muscles, face-to-face, one-on-one, each 15 minutes (including monitoring). Examples of use of this code might include: training in safe use of all modes of exercise, training in proper technique performing strength training, training in breathing strategies, training in inspiratory muscle training (IMT) in select patient who may benefit from IMT.
G0238
- Therapeutic procedures to improve respiratory function, other than ones described by G0237, one-on-one, face-to-face, per 15 minutes (including monitoring). This may involve a variety of activities, including teaching patients strategies for performing tasks with less respiratory effort including ADLs, airway clearance strategies, stair climbing, or other activities to improve functional capacity.
G0239
- Therapeutic procedures to improve respiratory function, two or more patients treated during the same period, face-to-face, (includes monitoring). This may involve a variety of activities similar to those listed under G0238, particularly group exercise. G0239 is not a timed code; it is billed once per day.