CMS NCD 362 Modified: Benson-Henry Institute Cardiac Wellness Program Coverage Update

CMS has issued a modification to National Coverage Determination (NCD) 362, which governs Medicare coverage of the Benson-Henry Institute Cardiac Wellness Program under the Intensive Cardiac Rehabilitation (ICR) benefit category. The Centers for Medicare & Medicaid Services originally established coverage for this program effective May 6, 2014, and this March 2026 update reflects a policy review cycle for billing teams and RCM directors managing cardiac rehabilitation claims. If your facility bills for ICR services, here's what you need to know before submitting claims.

What Is the Benson-Henry Institute Cardiac Wellness Program Under CMS Coverage?

The Benson-Henry Institute Cardiac Wellness Program is a multi-component cardiac rehabilitation intervention developed by Herbert Benson, MD, whose foundational research began in the mid-1960s with an investigation into the relationship between stress and hypertension. The program combines supervised exercise, behavioral interventions, and counseling, with the overarching goal of reducing cardiovascular risk and improving patient health outcomes.

CMS classifies this program under the Intensive Cardiac Rehabilitation (ICR) benefit category—a designation that carries specific program requirements set by Congress. ICR is a step above standard cardiac rehabilitation and requires a higher intensity of services, which affects how claims are structured and what documentation your team needs to support medical necessity.

The program meets ICR requirements as defined in §1861(eee)(4)(A) of the Social Security Act and the implementing regulations at 42 C.F.R. §410.49(c). For billing teams, these regulatory citations are worth bookmarking—they establish the statutory foundation that makes this program a covered Medicare benefit and are often referenced in audit contexts.

CMS Coverage Criteria for the Benson-Henry ICR Program (NCD 362)

Understanding what's covered—and what isn't—is the core of managing ICR claims correctly under this NCD.

Nationally Covered Indications

Effective for claims with dates of service on and after May 6, 2014, CMS covers the Benson-Henry Institute Cardiac Wellness Program when it meets ICR program requirements under §1861(eee)(4)(A) of the Social Security Act and 42 C.F.R. §410.49(c). The key condition: the program must appear on the official CMS list of approved ICR programs.

That list is maintained at cms.gov/Medicare/Medicare-General-Information/MedicareApprovedFacilitie/ICR. Before you submit a single claim under this program, confirm your specific program site is on that list. Approval is program-specific and site-specific—one facility's approval does not automatically extend to affiliated locations.

Nationally Non-Covered Indications

This is where billing teams get into trouble. CMS is explicit: if a specific ICR program is not included on the approved ICR program list, services are non-covered—full stop. There is no gray area here, no medical necessity argument that overrides program approval status, and no appeals path built on clinical documentation alone if your program simply isn't on the list.

This binary coverage rule means that the administrative step of confirming list status isn't optional—it's a prerequisite to billing.

Prior Authorization Requirements

NCD 362 does not specify prior authorization requirements within the policy text. However, billing teams should check applicable Medicare Administrative Contractor (MAC) guidance for your jurisdiction, as local coverage policies and payer-specific rules may layer additional requirements on top of the NCD.

Affected Codes

This policy does not list specific CPT or HCPCS codes within the NCD 362 policy document. For ICR billing under Medicare, you should reference your MAC's local coverage guidance and the relevant claims processing transmittals for applicable procedure codes.

CMS has issued two claims processing transmittals relevant to this NCD:

• Transmittal 3084 (Medicare Claims Processing): cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R3084CP.pdf
• Transmittal 12497 (Medicare Claims Processing): cms.gov/files/document/r12497cp.pdf

Your billing team should pull both transmittals and confirm that your claim submission process aligns with the instructions in the most recent one.

How ICR Differs from Standard Cardiac Rehabilitation for Billing Purposes

Standard cardiac rehabilitation and intensive cardiac rehabilitation are not interchangeable for billing. ICR programs must meet a higher regulatory bar—more sessions per day, more hours per week, and program-specific approval requirements that standard CR programs do not face.

The Benson-Henry Institute Cardiac Wellness Program qualifies specifically as ICR, which means it must be billed under the ICR benefit category rather than the standard cardiac rehabilitation benefit. Misclassifying these claims is a common audit target, so make sure your coders understand the distinction and that documentation in the medical record reflects the intensity of services delivered.

Patient eligibility criteria for ICR also differ from standard CR—the diagnoses that qualify a patient for ICR services should be documented clearly and linked to the services billed. Again, your MAC's local guidance is the governing authority for diagnosis-level eligibility rules.

What Your Billing Team Should Do