G0422 Intens cardiac rehab w/exercIntensive cardiac rehabilitation; with or without continuous ecg monitoring with exercise, per session
Status A: active, paid separately under the PFS if covered. National amounts: non-facility $131.60, facility $131.60 (total RVUs 3.94 / 3.94 × $33.4009 conversion factor). Work RVU 2.05, practice expense RVU 1.77 non-facility and 1.77 facility, malpractice RVU 0.12. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.
9 of 11 payer prior-auth lists that name G0422 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Ohio, Molina Healthcare of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | FEP Blue Focus only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2010 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2010 | Master Precertification List (For Health Care Providers) |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Other Services | |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | No PA required for 36 visits per rolling year | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | *Allow first visit for cardiopulmonary rehab without PA. All additional visits will… | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Allow first visit for cardiopulmonary rehab without PA. All additional visits will… | Jul 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
G0422 appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Cardiac Rehabilitation: Outpatient (0021) | covered if criteria are met | Mar 10, 2026 | payer document |
| Aetna | Heart Transplantation (0586) | listed, no stance | Sep 11, 2026 | payer document |
| Aetna | Intensive Cardiac Rehabilitation Programs (0267) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Outpatient Cardiac Rehabilitation (CG-REHAB-02) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Cardiac Rehabilitation In The Outpatient Setting (L.8.03.400) | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Cardiac Rehabilitation in the Outpatient Setting (916) | unproven / investigational | payer document | |
| BlueCross BlueShield of South Carolina | Cardiac Rehabilitation in the Outpatient Setting (CAM 80308) 93798 | ; with continuous ECG monitoring (per session) | listed, no stance | Aug 1, 2026 | payer document |
| Centene | Outpatient Cardiac Rehabilitation (CP.MP.176) | not covered | Feb 1, 2025 | payer document |
| Cigna | Cardiac Rehabilitation (Phase II Outpatient) (0073) | not covered | May 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Cardiac Rehabilitation in the Outpatient Setting (THE803.023) | listed, no stance | Sep 15, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.