Summary & Overview
HCPCS S9472: Cardiac Rehabilitation Program, Non-Physician, Per Diem
HCPCS Level II code S9472 denotes a per diem cardiac rehabilitation program provided by a non-physician clinician. This code captures daily delivery of structured cardiac rehab services — typically exercise training, patient education, risk-factor modification, and clinical monitoring — in outpatient clinic or rehabilitation settings. Nationally, cardiac rehabilitation coding and coverage affect access to secondary prevention after myocardial infarction, coronary revascularization, and heart failure, making clear coding important for utilization tracking and benefits design.
Key payers included in the coverage landscape are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, payer coverage context, and the clinical setting in which services are provided. The publication summarizes common billing practices, relevant modifiers where provided, and highlights typical use cases for per diem cardiac rehab billing. The material is intended to inform billing staff, revenue cycle teams, and policy analysts about the code’s clinical purpose and billing role at a national level.
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Billing Code Overview
HCPCS Level II code S9472 describes a cardiac rehabilitation program delivered by a non-physician provider and billed per diem. The service type is cardiac rehabilitation therapy and support services provided on a daily basis. The typical site of service is outpatient cardiac rehabilitation facilities or clinic-based cardiac rehab programs where patients attend structured exercise, education, and monitoring sessions under non-physician clinical staff supervision.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male recently discharged after an acute myocardial infarction with successful percutaneous coronary intervention. He is referred to a multidisciplinary cardiac rehabilitation program for supervised exercise training, risk-factor modification, education, and psychosocial support. The program is delivered by non-physician providers (cardiac rehabilitation nurses, exercise physiologists, and cardiac rehab therapists) in an outpatient cardiac rehabilitation center or hospital-based outpatient facility. Services are billed as a per diem under S9472 when the patient attends a day of structured cardiac rehabilitation that includes an individualized exercise session, vital sign monitoring, symptom assessment, and patient education.
Clinical workflow:
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The patient receives a physician referral and pre-participation evaluation, including medication reconciliation, baseline vitals, and exercise tolerance assessment.
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On each attendance day, non-physician staff perform pre-exercise screening, supervise aerobic and resistance training, monitor telemetry or vitals as indicated, provide brief education on diet/medications, and document progress.
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If an incident occurs (e.g., chest pain, hypotension), staff provide immediate care per protocol and notify the physician; such events may affect billing modifiers.
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Encounters are billed per diem with
S9472for each day of service provided by the non-physician team, with appropriate modifiers applied when medically indicated.