Did You Know? – Comprehensive Outpatient Rehabilitation Facilities/Outpatient Rehabilitation Therapy (CORF/OPT)
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- How can I determine if the outpatient therapy cap has been met?
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Outpatient therapy cap amounts can be accessed via the Interactive Voice Response (IVR), myCGS web portal, or Direct Data Entry (DDE).
In DDE, access the ELGA/HIQA inquiry. Page 01 includes the dollar amount applied toward both the physical therapy (which also includes speech therapy) and occupational therapy caps.
Example:
Patient A has not had any outpatient therapy services billed:
PT APL 0.00 OT APL 0.00Patient B has  had some outpatient therapy services billed, but has not met the PT or OT therapy cap:
PT APL 1174.81 OT APL 1324.45Reviewed 09/22/2021
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- Where can I find more information about billing social work and psychological services in Comprehensive Outpatient Rehabilitation Facilities (CORFs)?
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Coverage information and billing requirements for social and psychological services provided in a CORF can be found in the following:
- CMS Medicare Benefit Policy Manual (Pub. 100-02), chapter 12, section 40.7
- CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 5, section 100.11
Reviewed 09/22/2021
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- Do outpatient physical therapy facilities provide vaccinations?
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Vaccinations are not covered by Medicare when provided in an outpatient physical therapy (OPT) facility. Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 18, section 10.2.2
Reviewed 09/22/2021
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- Where can I find more information about therapy functional reporting?
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The Functional Reporting requirements of reporting the functional limitation non-payable HCPCS G-codes and severity modifiers on claims for therapy services and the associated documentation requirements in medical records have been discontinued, effective for dates of service on and after January 1, 2019. Information is still available for reporting requirements that were effective from January 1, 2013 – December 31, 2018.
Please reference the Functional Reporting page on the CMS website.
Reviewed 09/22/2021
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