Inpatient Rehabilitation Facility
This page is a central location for inpatient rehabilitation facility (IRF) information, including CMS resources.
Spotlight
CMS is exercising enforcement discretion on the 4-day initial IDT meeting requirement from October 1, 2026, through March 31, 2027. During this enforcement discretion period, timing requirement of the initial IDT meeting under 42 CFR § 412.622(a)(5)(ii), Basis of Payment that had been in effect during FY 2026, weekly IDT meetings are required, and all other IRF coverage and documentation requirements remain in effect.
Access educational materials, coverage guidance, and FAQs related to the FY 2027 IRF Prospective Payment System (PPS) Final Rule:
- Medicare Inpatient Rehabilitation Facility: FY 2027 Final Rule education (PDF)
- IRF: 36-Hour Requirement (PDF)
- IRF: Initial IDT Meeting (PDF)
- IRF: FY 2027 Final Rule Frequently Asked Questions (PDF)
Policy Information
Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage.
Medical Documentation
For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding and billing requirements and substantiate the level of care billed. The following resources are specific to IRFs, but may not address all required medical documentation requirements:
- Medical Documentation Checklists
- Checklist: IRF
- Documentation Requirements to Support Medical Necessity for IRF Stay
- IRF Coverage, Documentation Requirements and Common Errors
- Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program
- Medicare Provider Compliance Tips: Inpatient Rehabilitation Hospitals & Inpatient Rehabilitation Units
- MLN Matters Special Edition Article SE17036, Inpatient Rehabilitation Facility (IRF) Medical Review Changes
- OIG Report (A-04-23-08096), Unclear Medicare Requirements Led to Differing Interpretations of Inpatient Rehabilitation Facility Documentation, Coverage, and Billing Requirements
- OIG Report (A-01-15-00500), Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements
Claim Submission and Reimbursement
- CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 3, Section 20.2.3, 20.3, 20.7.2, 20.7.4 and 140
- Interim Billing Guidelines for Inpatient Acute-Care PPS Hospitals, IRFs, Long-Term Care Hospitals (LTCHs) and Inpatient Psychiatric Facilities (IPFs)
- MLN Matters Article MM13402, Processing Claims Affected by Retroactive Entitlement
- Part A Inpatient Date of Service Reporting and Split Billing
- Resolution Tips for Overlapping Claims
Additional Information
- View our FastTrack to Medicare Coverage Policies Tool to locate guidelines
- Targeted Probe and Educate (TPE) Round Results: IRF
CMS
- 42 CFR § 412.622, Basis of Payment
- Inpatient Rehabilitation Facility PPS
- Inpatient Rehabilitation Facility PPS Web Pricer
- Inpatient Rehabilitation Facilities Reason Codes and Statements
- IRF Quality Reporting Program (QRP)
- IRF Grouper - Case Mix Group (CMG)
- IRF-PAI
- IRF Rules and Related Files
- Medicare Payment Systems: Inpatient Rehabilitation Facility Prospective Payment System
Education
View our wide selection of free, live and on-demand training options:
- View our upcoming Educational Events Calendar
- View On-demand Learning
Stay Informed
Stay updated on the latest Medicare information with free email subscriptions: