TL;DR: The Centers for Medicare & Medicaid Services modified NCD 36, the cardiac rehabilitation programs coverage policy, with an update recorded January 9, 2026. This policy has been retired — but if your billing team is still routing cardiac rehab claims through NCD 36, you're billing against a repealed framework and that's a claim denial waiting to happen.
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Cardiac Rehabilitation Programs - RETIRED |
| Policy Code | NCD 36 |
| Change Type | Modified |
| Effective Date | 2026-01-09 |
| Impact Level | High |
| Specialties Affected | Cardiology, cardiac rehabilitation programs, outpatient hospital billing |
| Key Action | Stop referencing NCD 36 for cardiac rehab coverage determinations. Use Pub. 100-04, Chapter 32, Section 140 instead. |
CMS Cardiac Rehabilitation Coverage Policy History: Why NCD 36 Was Retired
The Centers for Medicare & Medicaid Services retired NCD 20.10 — the cardiac rehabilitation programs section of the National Coverage Determination manual — on February 22, 2010. That's not a typo. This policy was repealed over 15 years ago, under Section 144 of the Medicare Improvements for Patients and Providers Act (MIPPA).
So why does this matter now, in 2026? Because the January 9, 2026 update to NCD 36 in the CMS policy system is a formal signal. CMS is actively maintaining and flagging this retirement notice, which tells you something: billing teams are still looking here. If you or your staff search for CMS cardiac rehabilitation coverage policy guidance and land on NCD 36, you need to know immediately that you're in the wrong place.
The real authority is Pub. 100-04, Chapter 32, Section 140 — CMS's Claims Processing Manual. That's where the current billing guidelines, medical necessity criteria, and coverage rules actually live. NCD 36 will not help you. It will redirect you, and if you miss that redirect, your claims will reflect it.
CMS Cardiac Rehabilitation Coverage Criteria and Medical Necessity Requirements 2026
The NCD 36 framework no longer governs medical necessity determinations for cardiac rehabilitation. It was repealed because MIPPA created statutory Medicare coverage for cardiac rehabilitation programs — taking the question partly out of the NCD process and putting it directly into statute and claims processing instruction.
Under Pub. 100-04, Chapter 32, Section 140, cardiac rehabilitation billing is governed by specific medical necessity criteria tied to qualifying diagnoses. Whether cardiac rehabilitation is covered under Medicare depends on the patient's diagnosis, the program structure, and physician oversight requirements. NCD 36 speaks to none of that. It can't — it's retired.
Prior authorization is not a standard requirement for Medicare cardiac rehabilitation under the current framework, but that doesn't mean your claims are clean by default. Medical necessity documentation still drives reimbursement. If your records don't support the qualifying diagnosis and the physician supervision requirements in Section 140, you're exposed.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Cardiac rehabilitation programs (under NCD 36) | Retired — Not applicable | None listed under NCD 36 | Refer to Pub. 100-04, Ch. 32, Sec. 140 for current coverage criteria |
| Cardiac rehabilitation billing under active CMS framework | Covered (when medical necessity criteria met) | See Pub. 100-04, Ch. 32, Sec. 140 | NCD 36 does not govern current claim adjudication |
This policy does not list specific CPT or HCPCS codes. No codes appear in the NCD 36 policy data. For current cardiac rehabilitation billing codes and reimbursement rules, your team must reference the Claims Processing Manual directly.
CMS Cardiac Rehabilitation Billing Guidelines and Action Items 2026
The January 9, 2026 update to NCD 36 in the CMS system is a reminder that this retired policy is still circulating — and still creating confusion. Here's what your billing team should do now.
| # | Action Item |
|---|---|
| 1 | Audit your internal policy references before January 31, 2026. If your charge capture workflows, internal training documents, or billing guidelines reference NCD 36 as an active authority, update them. Pull every document that cites NCD 36 and replace the reference with Pub. 100-04, Chapter 32, Section 140. |
| 2 | Pull your current cardiac rehab billing guidelines from the correct source. Go directly to the CMS Claims Processing Manual, Pub. 100-04, Chapter 32, Section 140. That document controls coverage, medical necessity criteria, and documentation requirements for cardiac rehabilitation billing right now. |
| 3 | Check your MAC's local coverage determination (LCD) for cardiac rehab. Your Medicare Administrative Contractor may have issued an LCD with additional guidance specific to your region. LCDs add requirements that the national Claims Processing Manual doesn't always specify. Contact your MAC or check their website directly. |
| 4 | Review recent cardiac rehab claim denial patterns. If you're seeing denials on cardiac rehabilitation claims, check whether your denial codes point to documentation gaps, diagnosis mismatches, or program structure issues. None of those will be solved by NCD 36 — but they will be addressed in Section 140 and your MAC's LCD. |
| 5 | Update staff training. Anyone on your billing team who does cardiac rehab billing should know that NCD 36 is retired. This is a foundational reference point. If someone is citing it to justify coverage decisions, that's a training gap that will cost you in claim denials and rework. |
| 6 | Talk to your compliance officer if you're unsure how MIPPA changed your program's coverage rules. The 2010 statutory change under MIPPA was significant. If your program predates that change and your internal documentation hasn't been fully updated to reflect the current framework, loop in your compliance officer before your next billing cycle. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Cardiac Rehabilitation Under NCD 36
Covered CPT Codes (When Selection Criteria Are Met)
This policy does not list specific CPT or HCPCS codes. NCD 36 is retired, and no codes are associated with this policy record. The NCD 36 CMS system entry contains no code table.
For current CPT and HCPCS codes used in cardiac rehabilitation billing, reference Pub. 100-04, Chapter 32, Section 140 and your MAC's LCD. Codes commonly associated with cardiac rehabilitation include physician-supervised outpatient programs — but you must pull those code lists from the active policy source, not from NCD 36.
Key ICD-10-CM Diagnosis Codes
No ICD-10-CM codes are listed in the NCD 36 policy data. Diagnosis code requirements for cardiac rehabilitation medical necessity are governed by the active Claims Processing Manual and applicable LCDs. Do not infer diagnosis requirements from this retired NCD.
The Real Issue With Retired Policies Staying in the System
Here's what's frustrating about NCD 36. CMS still maintains and updates its entry in the NCD Manual system. The January 9, 2026 modification is a record-keeping and system update — not a clinical change — but it keeps this retired policy visible in searches and payer policy tools.
That visibility creates a real risk. A billing coordinator searching for "CMS cardiac rehabilitation coverage policy" can land on NCD 36 and, without reading carefully, assume it's current guidance. The policy text does redirect to Section 140, but only if you read the full text. In fast-moving billing environments, that redirect gets missed.
The effective date of NCD 36's retirement is February 22, 2010. That date matters because it's the anchor for any audit trail or compliance question. If a payor audit asks why your team made a coverage determination, "NCD 36 said so" is not a defensible answer for claims billed after February 2010.
Your billing team needs to treat NCD 36 as a historical artifact, not an active resource. The 2026 system update doesn't change that. It just means the artifact is still searchable — which is exactly why this post exists.
Get the Full Picture
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.