CMS Cardiac Rehabilitation NCD 36 Retired: What Billing Teams Need to Know in 2026

CMS's National Coverage Determination 20.10, governing cardiac rehabilitation programs under NCD 36, carries a "RETIRED" designation that continues to confuse billing and revenue cycle teams — particularly those new to Medicare or working with legacy documentation. The Centers for Medicare & Medicaid Services repealed this section of the NCD Manual on February 22, 2010, following the passage of Section 144 of the Medicare Improvements for Patients and Providers Act (MIPPA). The March 2026 modification to policy key 36-v4 updates the administrative record for this retired NCD, and understanding what that means for your billing workflow is essential to avoid chasing the wrong reference documents.

What CMS NCD 36 Actually Says — and Why It No Longer Controls Cardiac Rehab Coverage

NCD 36 (policy key 36-v4) contains a single operative instruction: this section was repealed. The full text directs providers to Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 140 for all cardiac rehabilitation coverage guidance. That redirect has been in place since April 2010, but the NCD record itself remains accessible in CMS databases, which means billing teams encountering it for the first time may not realize they're looking at a retired document.

The retirement of NCD 20.10 wasn't a coverage elimination — it was a jurisdictional transfer. MIPPA Section 144 established statutory coverage for cardiac rehabilitation and intensive cardiac rehabilitation programs, moving the governing authority from a discretionary NCD into law and the corresponding claims processing manual chapter.

This distinction matters for billing. An NCD controls coverage at the national level and can override local coverage determinations (LCDs). Once that NCD was repealed, cardiac rehab coverage terms became governed by the statutory framework and the instructions in Pub. 100-04, Chapter 32, Section 140 — which has been updated multiple times since 2010 and contains the actual medical necessity criteria, program requirements, and billing instructions your team should be using.

Why CMS Is Still Modifying a Retired Policy in 2026

Administrative updates to retired NCDs serve a real documentation purpose. CMS periodically revises these records to ensure cross-references remain accurate, revision histories are current, and the policy database reflects the correct redirect. The March 2026 modification to NCD 36-v4 follows a similar administrative update issued in March 2023 (Rev. 11892, effective April 10, 2023).

These modifications don't change clinical coverage. They don't add new eligibility criteria, alter prior authorization requirements, or create new billing obligations. What they do is signal to CMS auditors, MAC reviewers, and billing teams that the official record has been reviewed and the redirect to Pub. 100-04, Chapter 32, Section 140 remains the controlling reference.

If your team uses policy tracking tools that flag CMS modifications, this is the kind of change worth logging and closing quickly — note the administrative nature, confirm your internal references point to the correct manual chapter, and move on.

Where Cardiac Rehab Coverage Actually Lives: CMS Pub. 100-04, Chapter 32, Section 140

For anyone billing cardiac rehabilitation services to Medicare, the operative document is the Medicare Claims Processing Manual, Pub. 100-04, Chapter 32, Section 140. That chapter covers:

• Eligibility criteria for cardiac rehabilitation programs (CR) and intensive cardiac rehabilitation programs (ICR)
• Covered diagnoses, including acute myocardial infarction within the preceding 12 months, stable angina, heart valve repair or replacement, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty or coronary stenting, heart or heart-lung transplant, and stable chronic heart failure
• Session limits (up to 36 sessions for standard CR, with the ability to extend to 72 under medical necessity documentation)
• Physician supervision requirements and the "incident to" benefit category under which these services are billed
• Facility and program certification requirements

The benefit category for cardiac rehab services — as noted in NCD 36 itself — is "incident to a physician's professional service." That classification has downstream effects on supervision levels, place of service, and how claims must be constructed.

Affected Codes

This policy does not list specific CPT, HCPCS, or ICD-10 codes. NCD 36 contains no code-level coverage determinations because it was retired before any code-specific guidance was embedded in this record. All applicable billing codes for cardiac rehabilitation services are found in Pub. 100-04, Chapter 32, Section 140 and the associated MLN articles published by CMS.

What Your Billing Team Should Do