Insurance & Medicare
EECP Insurance & Medicare Coverage
Medicare covers EECP in one specific situation: disabling chronic stable angina (Canadian Cardiovascular Society Class III or IV) when a cardiologist or cardiothoracic surgeon determines you are not a good candidate for angioplasty or bypass surgery. That rule comes from CMS National Coverage Determination 20.20. Other conditions, including neuropathy and heart failure, are not covered under this determination.
- CMS NCD 20.20
- Medicare Reviewed
- Verify Before You Start
The Medicare Rule
What Does CMS National Coverage Determination 20.20 Say?
Medicare's coverage decision for external counterpulsation (NCD 20.20) defines when the therapy is covered. Under the determination, Medicare covers EECP for disabling chronic stable angina, meaning Canadian Cardiovascular Society Class III or Class IV, when a cardiologist or cardiothoracic surgeon finds that the patient is not a good candidate for angioplasty or bypass surgery.
In plain terms, Medicare built its coverage around the patients EECP is most often used for: people with severe, persistent angina who run out of surgical options.
Read CMS NCD 20.20Coverage at a Glance
- Covered: disabling chronic stable angina, CCS Class III or IV
- Requirement: a cardiologist or cardiothoracic surgeon finds you are not a good candidate for angioplasty or bypass
- Not covered under this determination: neuropathy, heart failure and other conditions
- Always verify your own coverage by calling the clinic
How It Works
What Medicare Does Not Cover
The 20.20 determination is narrow by design. Medicare does not cover EECP for neuropathy, heart failure, poor circulation or general wellness under this determination. That is not a comment on whether EECP might be discussed for those situations; it is simply what the coverage rule says.
For private insurance, each plan makes its own determination, and coverage varies widely. The only way to know what applies to you is to have the clinic verify your benefits with your plan, which we do before any program begins.
Learn the Criteria
Medicare covers EECP for disabling chronic stable angina (CCS Class III or IV) when you are not a good candidate for angioplasty or bypass, per CMS NCD 20.20.
Gather Documentation
A cardiologist or cardiothoracic surgeon's determination that you are not a good candidate is the key piece of documentation Medicare looks for.
Call to Verify
Call 385-330-0358 and the clinic will check your plan, explain what is needed and confirm next steps before you commit.
An Honest Word on Coverage
No one can promise you that Medicare or your insurance will cover EECP before your specific situation is reviewed. What we can promise: clear answers, real benefit verification and no surprises. The cost page explains the options, and a free consultation is the easiest way to get a straight answer about your case.
Questions
Insurance & Medicare FAQs
Straight answers to the questions patients ask us most. Something else on your mind? Give us a call or request a free consultation.
View All EECP FAQs Does Medicare cover EECP?
Yes, in a specific situation. Under CMS National Coverage Determination 20.20, Medicare covers EECP for disabling chronic stable angina (Canadian Cardiovascular Society Class III or IV) when a cardiologist or cardiothoracic surgeon determines the patient is not a good candidate for angioplasty or bypass surgery.
Does Medicare cover EECP for neuropathy?
No. Medicare's coverage determination for EECP (NCD 20.20) addresses qualifying refractory angina only. Medicare does not cover EECP for other conditions, including neuropathy. Coverage always depends on your plan, so call the clinic to verify your specific situation.
Does Medicare cover EECP for heart failure?
No. The CMS coverage determination applies to qualifying refractory angina, not heart failure or other conditions. Patients should verify their own coverage with the clinic and their plan.
What do I need to show for Medicare coverage?
Medicare expects documentation that you have disabling chronic stable angina (CCS Class III or IV) and that a cardiologist or cardiothoracic surgeon has determined you are not a good candidate for angioplasty or bypass surgery. The clinic can help you understand what your plan needs.
How do I verify my coverage before starting?
Call the clinic at 385-330-0358. The team will review your situation, help you understand what your plan may cover and tell you exactly what documentation is needed. We never promise coverage; we verify it with you before anything starts.
What if I do not have Medicare?
Private insurance plans vary widely in how they cover EECP. The first step is the same: call the clinic, and the team will check your benefits and explain your options, including self-pay, clearly.
Start Here
Have Questions About EECP?
Book a free consultation to talk with our team, review the research together and find out whether EECP may be worth discussing with your doctor.
Visit the Clinic
A Convenient Draper Location
Thrive EECP
1111 E Draper Pkwy
Draper, UT 84020
By appointment. Call ahead and we will find a time that works for you.
Easily reached from Sandy, South Jordan, Riverton, Herriman, Cottonwood Heights, Midvale, Murray, Lehi, Alpine, Highland and American Fork, along with other South Salt Lake Valley and northern Utah County communities.
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Book a Consultation
Reserve your appointment directly in the calendar below. Prefer to talk it through first? Call us at 385-330-0358 and our team will help you find a time that works for you.
385-330-0358
Prefer to book by phone
Thrive EECP
1111 E Draper Pkwy
Draper, UT 84020