Program_Memos / 2001 / AB-01-68

Why This Topic Matters

It explains how Medicare operational guidance for outpatient rehabilitation and related services was organized and updated in one memorandum. Readers can use it to determine whether the article contains billing, reporting, or payment guidance relevant to Medicare outpatient therapy and CORF claims.

Article Sections

1. Program Memorandum and Consolidation Background

   Introduces the memorandum, its relationship to earlier program memorandums, and the general subject area covered by the consolidation.

2. Prospective Payment and Financial Limitation Background

   Summarizes the statutory and policy background for outpatient rehabilitation services, including the payment framework and changes affecting financial limitations.

3. Therapy Moratorium, Review, and Expense Tracking

   Describes the temporary period addressed by the memorandum and the associated review and tracking instructions for outpatient rehabilitation claims.

4. HCPCS Coding Requirement and Applicable Bill Types and Revenue Codes

   Explains where HCPCS reporting applies and identifies the related bill types and revenue code categories for the services discussed.

5. Applicable Outpatient Rehabilitation HCPCS Codes

   Lists the HCPCS codes referenced for outpatient rehabilitation services and notes special exceptions and payment-related comments.

6. Applicable Audiology HCPCS Codes

   Lists the audiology-related HCPCS codes referenced and notes how they are treated in different settings.

7. HCPCS Coding Requirements for CORFs

   Covers HCPCS reporting requirements for comprehensive outpatient rehabilitation facilities and the categories of CORF services addressed.

8. Proper Reporting of Code G0128 by CORFs

   Provides CORF-specific reporting guidance and examples of service categories that are discussed in relation to nursing services.

9. Edit Requirements

   Describes edit-related instructions associated with revenue code and HCPCS reporting.

10. Reporting of Service Units

    Explains the reporting of units for outpatient rehabilitation, audiology, and CORF services, including general timing concepts and claim reporting considerations.

11. Determining What Time Counts Towards 15 Minute Timed Codes

    Addresses how treatment time is counted for timed codes and what portions of a visit are considered in the reporting framework.

12. Line Item Date of Service Reporting

    Describes how line-item dates of service are to be reported for the services covered in the memorandum and gives claim-format examples.

13. Payment

    Summarizes the Medicare payment approach used for the services discussed and the related claim-processing context.

14. Implementation of MPFS

    Explains the role of the Medicare Physician Fee Schedule for the service categories referenced and the general payment methodology.

15. Application of the Outpatient Mental Health Treatment Limitation

    Addresses the outpatient mental health treatment limitation as it relates to CORF services.

16. CWF and PS&R Requirements

    Covers claims-processing and reporting requirements for financial data and program statistics systems.

17. Discipline Specific Outpatient Rehabilitation Modifiers

    Describes modifier reporting associated with the discipline or plan of care under which outpatient rehabilitation services are furnished.

18. New CORF Requirement

    Explains updated CORF reporting and pricing-file requirements and the related operational options available to payers.

19. Coding Guidance for Certain Physical Medicine CPT Codes

    Provides guidance on selected physical medicine CPT codes and how they are addressed in the memorandum.