Comprehensive Outpatient Rehabilitation Facility (CORF) - JE Part A

Medicare provides coverage under Part B for outpatient therapy services such as physical therapy (PT), occupational therapy (OT) and speech language pathology (SLP). These services must be furnished by qualified professionals under an established plan of care. Such therapy services are subject to co-insurance, deductibles and an annual financial limitations cap.

Access the below CORF/ORFrelated information from this page.

• CORF Billing Guide
• CORF Services
• Enrollment
• Outpatient Rehabilitation Facility (ORF) Services
• Physician Orders and Certification Guidelines

CORF Services

A CORF facility primarily provides outpatient rehabilitation for Medicare beneficiaries who are injured, disabled or recovering from illness. The outpatient therapy benefit under Part B provides coverage only of therapy services. Payment can be made only for those services that represent skilled reasonably and necessary therapy services that are not excluded from coverage.

The following conditions apply:

• The CORF must provide three core services; a physician service, physical therapy and social or psychological services. CORFs may also provide optional rehabilitative and other medically necessary items and services.
• The CORF physician establishes the PT, OT, SLP plan of care (POC) and signs it prior to treatment in the CORF setting. PT, OT, SLP services are rendered while the beneficiary is under the care of a physician.
• Certification is required for coverage and payment of a therapy claim. The initial CORF therapy plan of treatment must be established and signed by the qualified physician prior to the start of treatment. For Medicare purposes, the qualified physician must be a doctor of medicine, doctor of osteopathy (including osteopathic practitioner), doctor of podiatry acting within scope of practice, or doctor of optometry for low vision services only. Note that referrals and certification for CORF services cannot be completed by a non-physician practitioner (NPP). The physician must review and recertify the POC during the duration of the plan of care or within 90 days, whichever is less. CORF claims must contain the National Provider (NPI) of the certifying physician identified for a PT, OT, and SLP plan of care.

Outpatient Rehabilitation Facility (ORF) Services

The outpatient therapy benefit under Part B provides coverage only of therapy services. Payment can be made only for those services that represent skilled reasonably and necessary therapy services that are not excluded from coverage.

The following conditions apply:

• The Medicare beneficiary must have a medical need. A plan of treatment has been established by a physician/NPP or by the therapist. ORF PT, OT, SLP services are rendered while the beneficiary is under the care of a physician.
• Certification is required for coverage and payment of a therapy claim. ORF services benefit will recognize a NPP for orders and certification. The referring physician must complete a timely initial certification of the POC within 30 days of completion. The physician must review and recertify the POC during the duration of the plan of care or within 90 days, whichever is less. ORF claims must contain the National Provider (NPI) of the certifying physician/NPP identified for a PT, OT, and SLP plan of care.

Resources

• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 12, Section 30 and 40
• CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220 and 230
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 5, Section 100
• CMS Change Request (CR) 8257 - Billing Social Work and Psychological Services in CORFs