CMS Pub. 100-02, ch. 12, § 20.1

Section 1861(cc) of the Act defines a CORF as a facility that is primarily engaged in

providing outpatient rehabilitation to the injured and disabled or to patients recovering

from illness. The CORF must provide the following core CORF services: a) CORF

physicians’ services, b) physical therapy services, and c) social and/or psychological

services. Physical therapy services should comprise a clear majority of the total CORF

services provided when the CORF offers the three core CORF services. A physician

must certify, as a condition of payment, that all CORF services are required because the

individual needs skilled rehabilitation services. Skilled rehabilitation services are defined

as services requiring the skills of physical therapists, speech-language pathologists or

occupational therapists. In addition, respiratory therapists are recognized to provide

skilled respiratory therapy services only under the CORF benefit.

A CORF is recognized as a provider of rehabilitation services. It is paid under the

physician fee schedule for all CORF services and items except for CORF physician

services (which are administrative in nature), drugs and biologicals and durable medical

equipment, prosthetics, orthotics, and supplies (DMEPOS). To participate in Medicare, a

CORF must furnish at least the following:

• CORF physicians’ services - includes professional services performed by a doctor

of medicine or osteopathy legally authorized to practice medicine and surgery by

the State in which he/she performs services. These services are administrative in

nature, such as consultation with, and medical supervision of, CORF qualified

personnel, patient case review conferences, utilization review, and review of the

rehabilitation plan of treatment, as appropriate. The physician must ensure that

CORF services are provided in accordance with accepted principles of medical

practice, medical direction and medical supervision. Subsequent to completing a

1-year hospital internship, the physician must have completed at least 1-year of

training in the medical management of patients requiring rehabilitative services

(42CFR485.70) or at least 1 year of full-time or part-time experience in a

rehabilitation setting providing physician services similar to those required in a

rehabilitation facility. A physician who specializes only in pulmonary

rehabilitation does not meet these requirements as he/she is not likely to have the

experience needed to medically manage patients that need physical therapy,

occupational therapy and speech-language pathology services. Diagnostic or

therapeutic services provided to a CORF patient by the CORF physician or other

physician are not CORF physician services. Such services are separately payable

to the physician and not the CORF under the physician fee schedule at the non-facility payment amount. These services should be billed as if they were provided

in the physician’s office. (See 42CFR410.100(a) and section 40.1.)

• Physical therapy services - include testing, measurement, assessment and

treatment of the function, or dysfunction, of the neuromuscular, musculoskeletal,

cardiovascular and respiratory system, and establishment of a maintenance

therapy program for an individual whose restoration potential has been reached

(See 42CFR410.100(b) and section 40.2); and

• Social and/or psychological services – are covered only if the patient’s physician

or the CORF physician establishes that the services directly relate to the patient’s

rehabilitation plan of treatment and are needed to achieve the goals in the

rehabilitation plan of treatment. Social and/or psychological services include only

those services that address the patient’s response and adjustment to the

rehabilitation treatment plan; rate of improvement and progress towards the

rehabilitation goals, or other services as they directly relate to the physical

therapy, occupational therapy, speech-language pathology, or respiratory therapy

plan of treatment being provided to the patient. CORF social and/or

psychological services do not include services for mental health diagnoses (See

42CFR410.100(h) and section 40.7.)

To receive Medicare payment for covered services, the CORF must have adequate space

and equipment necessary for any of the services provided. Additionally, in order to

accept a patient, the CORF must be able to provide all of the services required by the

patient, as established in the rehabilitation plan of treatment. If the CORF does not have

the necessary qualified personnel to provide the service(s), it must arrange for the

service(s) to be provided at the CORF, as needed.

Functional reporting is required on claims for CORF physical therapy, occupational

therapy, and speech-language pathology services by section 3005(g) of the Middle Class

Tax Relief and Jobs Creation Act (MCTRJCA) of 2012. (See 42CFR410.105 and

42CFR410.59, 60, and 62.) NOTE: Functional reporting and its associated

documentation requirements are no longer applicable for claims or medical records for

dates of service on and after January 1, 2019. See the NOTE at the beginning of

subsection F in Section 30 below for more information.

The CORF services are subject to the Medicare Part B deductible and coinsurance

provisions. The CORF may bill the beneficiary only for the unmet portion of the

deductible and 20 percent of the fee schedule amount for covered services.