US · guidance
CMS Pub. 100-04, ch. 5, § 40.8
Rebilling Therapy Services for Hospital Inpatients
If a beneficiary receives therapy services during an inpatient hospital stay which was
denied because the stay was not medically necessary, the therapy services may be rebilled
under Medicare Part B coverage. If the therapy would have been reasonable and
necessary as hospital outpatient services, and provided the beneficiary has Part B
entitlement, the services can be billed using Type of Bill 012x. All payment and billing
requirements for outpatient therapy (including therapy caps, functional reporting and
other instructions in this chapter) apply to these claims.
History
(Rev. 2868, Issued: 02-06-14, Effective: 07-01-14, Implementation: 07-07-14)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1dd2d72f7d227088cae9651537294baa698712f43cda59369aa1454e9b7995a0
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