CMS Revises Ornish and Pritikin Program NCDs

The Centers for Medicare & Medicaid Services (CMS) recently revised the national coverage determinations (NCDs) for both the Ornish Program for Reversing Heart Disease (section 20.31.2 of the NCD Manual) and the Pritikin Program (section 20.31.1 of the NCD Manual).

Effective Aug. 12, both programs have been determined to meet the Intensive Cardiac Rehabilitation (ICR) program requirements and have been added to the list of approved ICR programs.

The Ornish Program for Reversing Heart Disease (also known as the Multisite Cardiac Lifestyle Intervention Program, the Multicenter Cardiac Lifestyle Intervention Program, and the Lifestyle Heart Trial Program) incorporates comprehensive lifestyle modifications including exercise, a low-fat diet, smoking cessation, stress management training, and group support sessions.

The Pritikin Program (also known as the Pritikin Longevity Program) is a comprehensive program that is provided in a physician’s office and incorporates a specific diet (10-15 percent of calories from fat, 15-20 percent from protein, 65-75 percent from complex carbohydrates), exercise, and counseling lasting 21-26 days. An optional residential component is also available for participants.

Contractors will not mass-adjust claims from Aug. 12 through the Oct. 25 implementation date, but providers may request an adjustment.

Refer to CMS Transmittals 126, 170, and 337, issued May 21, for claims processing coverage, coding and payment information regarding ICR.

Source: CMS Transmittal 125, Change Request (CR) 7113, issued Sept. 24


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One Response to “CMS Revises Ornish and Pritikin Program NCDs”

  1. Ayushman says:

    Can someone throw some light on what CPT codes are currently being used for the Ornish and Pritikin Programs?

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