Program_Memos / 2000 / AB-00-01

Why This Topic Matters

These instructions affect how certain therapy, audiology, and CORF claims are reported and processed under Medicare, including payment methodology and administrative tracking. The memorandum is relevant for organizations that submit or adjudicate outpatient rehabilitation claims and need to align system edits, reporting fields, and program rules with HCFA guidance.

Article Sections

1. Subject and background

   Introduces the memorandum, its change request context, and the general Medicare policy background for outpatient rehabilitation services.

2. Prospective payment system for outpatient rehabilitation services

   Explains the payment framework for outpatient rehabilitation services and identifies the provider settings and service categories addressed.

3. Implementation of MPFS (Intermediaries)

   Describes intermediary processing requirements, fee schedule file handling, and related payment administration steps.

4. Application of the outpatient mental health treatment limitation

   Addresses how the memorandum discusses the outpatient mental health treatment limitation in relation to covered services.

5. CWF and PS&R requirements (Intermediaries)

   Summarizes claims reporting and system record requirements for intermediary processing and reporting outputs.

6. Background regarding financial limitation

   Covers the broader annual limitation framework discussed in the memorandum and the time period to which it applies.

7. Application of financial limitation (Intermediaries)

   Addresses intermediary responsibilities for monitoring beneficiary expense limits and related claim handling processes.

8. Application of financial limitation (Carriers)

   Summarizes carrier-side tracking responsibilities and related handling for providers subject to the limitation.

9. Outpatient rehabilitation HCPCS codes (Intermediaries and Carriers)

   Lists the HCPCS codes associated with outpatient rehabilitation services and notes accompanying reporting considerations.

10. Audiology HCPCS codes (Intermediaries and Carriers)

    Lists audiology-related HCPCS codes covered by the memorandum and notes their separate treatment under the payment framework.

11. CORF HCPCS codes (Intermediaries)

    Identifies additional HCPCS codes used for CORF service reporting and their payment category context.

12. Revenue codes

    Identifies the revenue code categories referenced for outpatient rehabilitation, audiology, and CORF reporting.

13. Bill types

    Lists the bill type categories referenced for the services covered in the memorandum.

14. Discipline specific outpatient rehabilitation modifiers

    Describes the reporting modifiers referenced for distinguishing therapy discipline and plan-of-care context.

15. Additional reporting requirements

    Notes supplemental reporting expectations for outpatient rehabilitation, audiology, and CORF claims.

16. Attachment: Record layout

    Provides the structure of the accompanying file layout and data elements used for processing and payment administration.