CMS Pub. 100-04, ch. 5, § 100.1

The Omnibus Reconciliation Act of 1980 (Public Law 96-499, Section 933) defines

CORFs (Comprehensive Outpatient Rehabilitation Facilities) as a distinct type of

Medicare provider and adds CORF services as a benefit under Medicare Part B. The

Balance Budget Act (P.L.105-33) requires payment under a prospective system for all

CORF services.

See Chapter 1, for the policy on A/B MAC (A) designations governing CORFs.

See the Medicare Benefit Policy Manual, Chapter 12, for a description of covered CORF

services.

Physicians’ diagnostic and therapeutic services furnished to a CORF patient are not

considered CORF physician’s services. The physician must bill the area A/B MAC (B)

for these services. If they are covered, the A/B MAC (B) reimburses them via the MPFS.

However, other services are considered CORF services to be billed by the CORF to the

A/B MAC (A), and are also considered included in the fee amount under the MPFS.

These services include such services as administrative services provided by the physician

associated with the CORF, examinations for the purpose of establishing and reviewing

the plan of care, consultation with and medical supervision of nonphysician staff, team

conferences, case reviews, and other facility staff medical and facility administration

activities relating to the services described in Medicare Benefit Policy Manual, chapter

12. Related supplies are also included in the MPFS fee amount.

The CORFs bill Medicare with the ASC X12 837 institutional claim or Form CMS-1450

using HCPCS codes and Revenue Codes. Usually the zero level revenue code is used.

Payment is based on the HCPCS code and related MPFS amount.

Requirements in §§10 - 50 apply to CORF billing. In addition the following

requirements apply.