Program_Memos / 2000 / AB-00-39

Why This Topic Matters

It brings together multiple prior memoranda into one operational reference for Medicare outpatient therapy billing and processing. The article helps readers understand the scope of outpatient rehabilitation and CORF guidance, the affected time periods, and the administrative changes that were in effect for claims handling.

Article Sections

1. Prospective Payment for Outpatient Rehabilitation Services and the Financial Limitation - Background

   Background on the Medicare framework for outpatient rehabilitation services, including the shift to prospective payment and related legislative context.

2. Section 221 of the Balanced Budget Refinement Act of 1999 Revision of Provisions Relating to Therapy Services - Intermediaries and Carriers

   General discussion of statutory revisions affecting therapy services during the 2000–2001 period and the related administrative changes for claims processing.

3. Tracking of Incurred Expenses - Intermediaries and Carriers

   Overview of expense-tracking expectations for outpatient rehabilitation services during the applicable prior period and the change in reporting expectations afterward.

4. Review to Determine Compliance With Therapy Financial Limitations - Intermediaries and Carriers

   General review and claim-processing instructions related to the therapy financial limitation for claims in different date-of-service periods.

5. CWF Removal Of Editing for the Financial Limitation - Carriers

   Administrative note on claims editing changes in the Common Working File environment for therapy claims.

6. Medical Review of Therapy Services - Intermediaries and Carriers

   Discussion of medical review activities for therapy services and the limited places of service addressed in the interim guidance.

7. HCPCS Coding Requirement - Intermediaries

   General coding requirements for institutional outpatient rehabilitation, audiology, and CORF services under HCPCS, including provider and billing context.

8. Applicable Bill Types - Intermediaries

   Bill type categories associated with HCPCS reporting for the services addressed in the memorandum.

9. Applicable Revenue Codes - Intermediaries

   Revenue code categories associated with outpatient rehabilitation and audiology reporting.

10. Applicable Outpatient Rehabilitation HCPCS Codes - Intermediaries

    Lists the HCPCS codes referenced for outpatient rehabilitation services and notes associated with selected identifiers.

11. Applicable Audiology HCPCS Codes - Intermediaries

    Lists the HCPCS codes referenced for audiology services and related payment context.

12. HCPCS Coding Requirements for CORFs - Intermediaries

    General CORF coding requirements and the additional service categories addressed for these facilities.

13. Proper Reporting of Code G0128 by CORFs - Intermediaries

    Additional CORF reporting context for a specific HCPCS code, including the types of nursing service documentation discussed in the memorandum.

14. Edit Requirements - Intermediaries

    Claim edit instructions related to the presence of HCPCS reporting when certain revenue codes are used.

15. Reporting of Service Units - Intermediaries and Carriers

    Instructions on how service units are to be reported for outpatient rehabilitation, audiology, and CORF claims.

16. Determining What Time Counts Towards 15 Minute Timed Codes - Intermediares

    General timing and documentation guidance for timed therapy services billed under CPT-based reporting.

17. Line Item Date of Service Reporting - Intermediaries

    Reporting requirements for line-item dates of service across applicable claim formats and billing situations.

18. Payment - Carriers

    General carrier payment framework under the Medicare Physician Fee Schedule for outpatient rehabilitation therapy services.

19. Implementation of MPFS - Intermediaries

    How the Medicare Physician Fee Schedule applies to qualifying outpatient therapy, audiology, and CORF services in the intermediary environment.

20. Application of the Outpatient Mental Health Treatment Limitation - Intermediaries

    General outpatient mental health payment limitation context as it relates to CORF services.

21. CWF and PS&R Requirements - Intermediaries

    Reporting and system requirements involving financial data records and cost/reporting systems.

22. Discipline Specific Outpatient Rehabilitation Modifiers - Intermediaries and Carriers

    General discussion of discipline-specific modifiers used for data collection in outpatient rehabilitation reporting.

23. New CORF Requirement - Intermediaries

    New CORF coding and pricing workflow requirements, including abstract and supplemental file access and retrieval timing.

24. Coding Guidance for Certain Physical Medicine CPT Codes - Intermediaries and Carriers

    Additional guidance for selected physical medicine CPT-based services and their reporting context.