CMS Pub. 100-02, ch. 12, § 30

A. Place of Treatment

In general, CORF services, except for physical therapy, occupational therapy, speech-language pathology services, and the single home environment evaluation, must be

furnished on the premises of the CORF. Physical therapy, occupational therapy, and

speech-language pathology services provided in the home are not covered as CORF

services if payment for such services is made under the Medicare home health benefit.

Although, physical therapy, occupational therapy, and speech-language pathology

services can be furnished in the patient’s home, a majority of these services must be

provided on the CORF premises for all CORF patients.

A single, home environment evaluation visit is a covered CORF service if it is included

in the physical therapy, occupational therapy or speech-language pathology plan of

treatment.

A CORF cannot provide items or services that are not included in the definition of CORF

services at 42CFR410.100 other than vaccines (CY 2008 PFS Rule 72 FR 66293). Those

services included in the definition of CORF services are covered only to the extent that

they support or further the rehabilitation plan of treatment.

B. Personnel Qualification Requirements

Services must be furnished or supervised by qualified personnel in accordance with

regulation 42CFR485.70. Payment for social and/or psychological services, nursing

services and respiratory therapy services is made when provided as specified in sections

40.7, 40.8 and 40.5 respectively of this chapter, as appropriate.

Determinations regarding whether services are furnished in accordance with the

conditions of participation and under the supervision of qualified personnel as noted at

section 20.2 are primarily the responsibility of the State survey agency responsible for

survey and certification of the facility. If services are not being furnished or

appropriately supervised by qualified personnel, the Medicare contractor will withhold

payment until the matter is resolved, as appropriate.

C. Services Furnished Under Arrangements

Any CORF service defined in §§20 or 40 may be furnished under arrangement and must

meet the requirements of Pub. 100-01 chapter 5, section 10.3.

D. Referral for Treatment

To become a patient of a CORF, the beneficiary must be under the care of a physician

who certifies that the beneficiary needs skilled rehabilitation services.

The referring physician must advise the CORF of the beneficiary’s medical history,

current diagnosis and medical findings, desired rehabilitation goals, and any

contraindications to specific activity or intensity of rehabilitation services. If the

rehabilitation goals for physical therapy, occupational therapy, speech-language

pathology or respiratory therapy services are not specified by the referring physician, the

CORF physician must establish them.

E. Plan of Treatment

The CORF services must be furnished under a written rehabilitation plan of treatment

established and signed by a physician who has recently evaluated the patient. It is

expected that the physician will establish the rehabilitation plan of treatment in

consultation with the physical therapist, occupational therapist or speech-language

pathologist who will provide the actual therapy. The physician wholly establishes the

respiratory therapy plan of treatment. The physician may be either a CORF physician or

the patient’s referring physician if the physician provides a detailed rehabilitation plan of

treatment that meets the following requirements.

The rehabilitation plan of treatment must be established and signed by a physician prior

to the commencement of treatment in the CORF setting and contain the diagnosis, the

type, amount, frequency, and duration of skilled rehabilitation services to be performed,

and the anticipated skilled rehabilitation goals. The services furnished under the

rehabilitation plan of treatment must be reasonable and medically necessary and relate

directly to the rehabilitation of injured, disabled, or sick patients. The skilled

rehabilitation goals for physical therapy, occupational therapy, and speech-language

pathology plans of treatment must be consistent with those used for the Functional

reporting pursuant to 410.105(d). For related documentation requirements, see subsection

F below. For more details on documentation requirements, refer to chapter 15, section

220.3, of this manual. NOTE: Functional reporting and documentation requirements are

no longer applicable for claims for dates of service on and after January 1, 2019. For

more information, refer to the NOTE in subsection F below.

The CORF physician or the referring physician for physical therapy, occupational therapy

and speech-language pathology services, must review the plan of treatment at least once

every 90 days certifying that the patient needs or continues to need skilled rehabilitation

services, the rehabilitation plan of treatment is being followed and that the patient is

making progress in attaining the established rehabilitation goals. The 90-day period

begins with the first day of rehabilitation therapy. For respiratory therapy services, the

CORF physician or the patient’s referring physician must review the rehabilitation plan

of treatment at least every 60 days. The 60-day period begins with the first day of

respiratory therapy treatment. (For survey and certification the plan of treatment review

must meet the requirements at 42CFR 485.58(b)). When the patient has reached a point

where no further progress is being made toward one or more of the rehabilitation goals,

or the skills of a therapist are no longer required, Medicare coverage ends with respect to

that aspect of the rehabilitation plan of treatment.

F. Functional Reporting and Documentation Requirements for Physical Therapy,

Occupational Therapy, and Speech-language Pathology Services.

NOTE: In the calendar year (CY) 2019 Physician Fee Schedule (PFS) final rule, CMS-1693-

F, after consideration of stakeholder comments for burden reduction, a review of all of the

requirements under section 3005(g) of Middle Class Tax Relief and Jobs Creation Act of

2012 (MCTRJCA), and in light of the statutory amendments to section 1833(g) of the Act, via

section 50202 of Bipartisan Budget Act of 2018 to repeal the therapy caps, CMS concluded

that continued collection of functional reporting data through the same or reduced format

would not yield additional information to inform future analyses or to serve as a basis for

reforms to the payment system for therapy services. To reduce the burden of reporting for

providers of therapy services, the CY 2019 PFS final rule ended the requirements of

reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on

claims for therapy services and the associated documentation requirements in medical

records, effective for dates of service on and after January 1, 2019. The rule also revised

regulation text at 42 CFR 410.59, 410.60, 410.61, 410.62, 410.105, accordingly.

The instructions below apply only to dates of service when the functional reporting

requirements were effective, January 1, 2013 through December 31, 2018.

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.)

The regulations implementing Section 3005(g) of the MCTRJCA require that nonpayable

G-codes and severity modifiers be used to report the functional status of CORF patients

receiving physical therapy, occupational therapy, and speech-language pathology

services. This functional reporting is required to be included on claims at the beginning

of treatment/outset of therapy, at specified reporting intervals which are consistent with

those for progress reporting, and at discharge from therapy. In addition, functional

reporting is required when an evaluative procedure, including a re-evaluative one, is

billed. The functional G-codes and severity modifiers used in reporting the patient’s

functional status shall be documented in each patient’s medical record. Refer to chapter

15, section 220 of this manual for instructions on selecting and documenting these

functional G-codes and severity modifiers in the patient’s medical record.

For details about the functional reporting requirements for G-codes and severity

modifiers on claims for therapy services, see Pub. 100-04, Medicare Claims Processing

Manual, chapter 5, section 10.6.