Medicare Approves 36 Cardiac Rehab Sessions After a Heart Attack. Each One Is a Separate 20% Bill, and at the Hospital It’s More

A 68-year-old comes home after a heart attack with a prescription for cardiac rehabilitation. His cardiologist says Medicare covers it, which is true. He signs up at the hospital’s outpatient rehab center, three visits a week. The first bill is small enough to ignore. So is the second. It’s somewhere around the tenth envelope that he does the back-of-the-napkin math nobody did for him at intake, and realizes he has 26 more of these coming.

Nothing was billed incorrectly. Cardiac rehab is a covered benefit that arrives as dozens of separate charges, and where you attend changes what each one costs. If you’re helping a parent through recovery, or facing this yourself, the mechanics below are worth 10 minutes before the first session.

What Medicare Actually Covers

Under Part B, Medicare covers regular cardiac rehabilitation after a heart attack, bypass, stent, valve repair, stable angina, transplant, or stable chronic heart failure. The standard benefit runs up to two one-hour sessions per day, up to 36 sessions over up to 36 weeks. Intensive cardiac rehab runs up to 72 sessions. One qualification that matters more than it sounds: Medicare can approve up to 36 additional regular sessions when they’re medically necessary. So a missed session isn’t automatically lost, though nobody should plan around the extension.

Here’s where the common explanation goes wrong. You don’t pay the Part B deductible and then 20% of everything after it. You pay the full approved amount for your early sessions until whatever remains of your $283 annual deductible is satisfied. Then you pay 20% of the approved amount for every session after that. The deductible isn’t necessarily consumed on the first visit, and if you’ve already met it through other Part B claims that year, you start at 20% immediately. Someone who just had a heart attack has usually generated enough Part B activity to clear the deductible well before rehab begins.

Same Treadmill, Two Different Prices

Medicare pays a physician office under the Physician Fee Schedule and a hospital outpatient department under a separate system, and the two produce meaningfully different numbers for identical care. Using 2026 national figures for code 93798, the hospital outpatient payment runs around $131.70, which produces roughly $26.34 in cost-sharing per session. The physician-office approved amount is closer to $26, producing roughly $5 per session. Across a full 36-session course, that difference compounds:

• If your deductible is already met: roughly $188 at a physician office, against roughly $948 at a hospital outpatient department.
• If your deductible is completely unmet: roughly $414 at a physician office, against roughly $1,175 at the hospital.

The gap between the two settings runs to approximately $761 for the same 12 weeks of the same treatment. Same exercise physiologist, same equipment, same hour.

What Medigap and Advantage Change

Original Medicare enrollees with Medigap Plan G pay the Part B deductible and nothing further on these sessions, for Medicare-covered services from providers who accept assignment. Plan G absorbs the coinsurance regardless of setting, which makes a recurring 20%-of-something benefit exactly the kind of exposure it was built for.

Plan N generally covers the Part B coinsurance after the deductible too. Its office-visit copay doesn’t necessarily attach to rehab sessions billed under these codes, so it’s worth asking your insurer rather than assuming.

Medicare Advantage members face plan-specific cost-sharing that varies widely, and prior authorization is common. The plan’s in-network out-of-pocket maximum caps the year, but that ceiling typically sits well above a rehab course’s running total, so it rarely intervenes mid-treatment. Cardiac rehab is one of several Medicare benefits where “covered” and “free” are different words. We mapped the rest, from IRMAA surcharges to coverage gaps, in a free guide to Medicare’s hidden bills.

What to Do Sooner Than Later

The following three steps won’t take long and can save you time and frustration down the line:

• Ask your cardiologist for both options. A hospital outpatient program and a freestanding or physician-office program. Where the geography allows it, the office setting can cut your cost-sharing substantially.
• Call the specific rehab center’s billing office and ask for the Medicare-approved amount at that address for code 93797 or 93798, whichever they bill. Intensive cardiac rehab uses different codes, G0422 and G0423. Ask for the per-session dollar figure, not “20%.”
• Learn whether your deductible has already been met this year. After a hospitalization it usually has, which changes your total meaningfully and is worth knowing before you compare programs.

Thirty-six sessions is a real benefit and most people should use all of it. Just find out what one session costs at each address before you pick one, because that single number, repeated three dozen times, is the whole bill.

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