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Comprehensive Outpatient Rehabilitation Facilities and Outpatient Physical Therapy Providers: Understanding the Differences

Medicare provides coverage under Part B for outpatient therapy services such as physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP). These services must be furnished by qualified professionals under an established plan of care. A Comprehensive Outpatient Rehabilitation Facility (CORF) and an Outpatient Physical Therapy (OPT) are not hospital outpatient departments; they are distinct Medicare-certified facilities that furnish outpatient therapy and rehabilitation services under their own Medicare participation and billing requirements. This article details the distinctions between CORFs and OPTs that affect how services are delivered, documented, and billed to Medicare. 

CORF Services

A CORF is a facility that is primarily engaged in providing diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of the injured and disabled or patients recovering from an illness. The CORF must provide a comprehensive, coordinated skilled rehabilitation program for its patients that includes, at minimum, CORF physicians’ services, physical therapy services, and social and/or psychological services. CORFs may also provide optional rehabilitation and other medically necessary items and services. The facility must have adequate space and equipment necessary for any of the services provided. In general, all services must be furnished on the premises of the CORF. The only exception is home evaluations.

The CORF physician establishes the PT, OT, SLP plan of care (POC) and signs it prior to the start of treatment in the CORF setting. PT, OT, SLP services are rendered while the beneficiary is under the care of a physician. The physician must review and recertify the POC at least every 90 days and every 60 days for respiratory services.

CORF claims must contain the NPI of the certifying physician identified for a PT, OT, and SLP plan of care.

CORFs use a 75X type of bill (TOB) when submitting claims to Medicare. 

OPT Services

An OPT or rehabilitation agency is a provider of service with an agreement to provide outpatient therapy services to beneficiaries. This was formerly referred to as an outpatient rehabilitation facility (ORF). 

The outpatient therapy benefit under Part B provides coverage only of therapy services. Reimbursement for OPT services is limited to reasonable and necessary skilled therapy services that meet Medicare coverage requirements. The beneficiary must have a medical need and a plan of treatment established by a physician, nonphysician practitioner (NPP) or therapist. The beneficiary must be under the care of a physician.

The physician must review and recertify the POC at least every 90 days. 

OPT claims must contain the NPI of the certifying physician/NPP identified for a PT, OT, and SLP plan of care.

OPTs use a TOB 74x when submitting claims to Medicare.

 

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