CMS Pub. 100-04, ch. 12, § 80.1

Outpatient Rehabilitation Facility

(Rev. 1, 10-01-03)

B3-2220

Rehabilitation services furnished by comprehensive outpatient rehabilitation facilities

(CORFs) are covered by Medicare Part B.

Under §1832(a)(2)(E), and §1861(cc)(2) (go to

http://www.ssa.gov/OP_Home/ssact/title18/1800.htm and select the applicable title) and

related provisions of the Act, a CORF is recognized as a provider of services on the basis of

its reasonable costs. Except for diagnostic and therapeutic services provided by physicians

to individual patients, payment is made to the CORF by A/B MACs (A) (acting in the role

of the A/B MAC (B).)

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

considered CORF physician’s services. Instead they are services that the physician must

bill to the A/B MAC (B). If covered services, payment is made according to the Medicare

Physician Fee Schedule. When physician’s diagnostic and therapeutic services are

furnished in a CORF, the claim must be annotated to show the CORF as the place of

treatment.

Services considered administrative services provided by the physician associated with the

CORF are considered CORF services reimbursable to the CORF by the A/B MACs (A).

Administrative services include consultation with and medical supervision of nonphysician

staff, establishing and reviewing the plan of treatment, and other medical and facility

administration activities.