Page 232 - Medicare Benefit Policy Manual

Medicare Part A or B Consolidated Hospital
Billing Rules May Bill
Apply? For
Outpatient
Services?

Part A (Medicare Covered / PPS) Yes No
Resident in Medicare-certified
part of a SNF

Medicare Part B Resident in Yes No
Medicare-certified part of a SNF

Medicare Part B No Yes
Not a Resident in Medicare-
certified part of a SNF

• A hospital may not send therapy staff to provide therapy services in non-
residential health care settings and bill for the services as if they were
provided at the hospital, even if the hospital owns the other facility or entity.
Examples of such non-residential settings include CORFs, rehabilitation
agencies, ORFs and offices of physicians/NPPs or other practitioners, such as
physical therapists. For example, services furnished to patients of a CORF
must be billed as CORF services and not as outpatient hospital services. Even
if a CORF contracts with a hospital to furnish services to CORF patients, the
hospital may not bill Medicare for the services as hospital outpatient services.
However, the CORF could have the hospital furnish services to its patients
under arrangements, in which case the CORF would bill for the services.

Psychiatric hospitals are treated the same as other hospitals for the purpose of therapy
billing.

231 - Pulmonary Rehabilitation (PR) Program Services Furnished On
or After January 1, 2010
(Rev. 11426; Issued: 05-20-22; Effective: 01-01-22; Implementation: 07-05-22)

Pulmonary rehabilitation (PR) means a physician-supervised program for chronic
obstructive pulmonary disease (COPD) and certain other chronic respiratory diseases
designed to optimize physical and social performance and autonomy. Effective January 1,
2010, Medicare Part B pays for PR if specific criteria are met by the Medicare
beneficiary, the PR program itself, the setting in which it is administered, and the
physician administering the program, as outlined below.

Covered Conditions: