CMS Pub. 100-02, ch. 12, § 10

Provided by Medicare

(Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26- 09)

The purpose of a Comprehensive Outpatient Rehabilitation Facility (CORF) is to permit

the beneficiary to receive multidisciplinary rehabilitation services at a single location in a

coordinated fashion.

Section 1861(cc) of the Social Security Act specifies that no service may be covered as a

CORF service if it would not be covered as an inpatient hospital service if provided to a

hospital patient. This does not mean that the beneficiary requires a hospital level of care

or meets other requirements unique to hospital care. This provision merely requires that

the service, if otherwise covered, would be covered if provided in a hospital.

CORF services are covered only if they relate directly to the rehabilitation for the

treatment of injured, disabled, or sick patients. CORF services are not covered if not

reasonable and medically necessary for the diagnosis, or treatment of illness, or injury, or

to improve the function of a malformed body member. Thus, there must be potential for

restoration or improvement of lost or impaired functions. For example, treatments

involving repetitive exercises (i.e., maintenance programs, general conditioning or

ambulation) that do not require the skilled services of physical therapists, occupational

therapists, speech-language pathologists or respiratory therapists are not covered.

Nonmedical personnel such as family members or exercise instructors could perform

these activities in the patient’s residence. It is not reasonable and medically necessary for

such activities to be performed in a CORF setting by CORF personnel. See 42CFR

410.100 and sections 20.1 and 20.2 of this chapter for the list of required and optional

services provided in a CORF.

CORF services do not include the following: a) provision of hyperbaric oxygen services,

b) infusion therapy services, c) cardiac rehabilitation services, or d) diagnostic sleep

studies. They do not meet the definition of a CORF services and/or they do not relate to

the rehabilitation plan of treatment. These services, and other services not specifically

listed as CORF services, may be covered under another Medicare benefit category, such

as physician services, incident-to physician services, and diagnostic services.

Physical therapy, occupational therapy, and speech-language pathology services may be

furnished in the patient’s home, as CORF services, when payment for these therapy

services is not otherwise made under the Medicare home health benefit. However, since

the CORF premise is the primary location for furnishing these services, it is expected that

a clear majority of the physical therapy, occupational therapy and speech-language

pathology services delivered will be provided on the CORF premises for all CORF

patients.

In addition to the above noted services, which may be provided in the home, a single

home environment evaluation visit is a covered CORF service if it is included in the

rehabilitation plan of treatment. The patient must be present during the home

environment evaluation that is performed by the physical therapist, occupational

therapist, or speech-language pathologist, as appropriate. The patient’s presence is

necessary to assess the patient’s current or future ability to function safely in the home

environment and to determine the potential impact the home situation will have on the

patient’s rehabilitation goals.

Services provided under the “incident to” benefit may not be recognized as CORF

services. Services furnished by CORF personnel, including registered nurses, physical

therapists, occupational therapists, speech-language pathologists, respiratory therapists,

social workers and psychologists are not considered as furnished incident-to physician

services.

The CORF physician must be present in the facility for a sufficient time to ensure that

CORF services are provided in accordance with accepted principles of medical practice.

All CORF services must be provided within acceptable professional standards and

practice (§§42CFR485.70, and 410.100).