Date: March 22, 2024
Attention: Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) Providers
Effective Date: June 1, 2024
Call to action: The purpose of this communication is to make providers aware of a new reimbursement policy for Texas Children’s Health Plan (TCHP), which outlines the billing requirements for Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Rehabilitation Facility (ORF) provider types. This policy applies to CHIP and Medicaid lines of business. This policy does not apply to ECI, Home Health, Individual Therapist, and Therapy Group provider types.
How this impacts providers: Policy guidelines are as follows:
CORF and ORF providers must bill services on a CMS-1450 (UB-04) claims form. Services billed on a CMS-1500 will be denied. Claims must be billed with the correct Type of Bill (TOB) of 75X for CORF providers and 74X for ORF providers. Using the incorrect TOB will result in claim denials.
Claims must be billed with the appropriate revenue code for therapy services with the correct corresponding procedure code (HCPCS/CPT). Reimbursement for therapy services will be based on the fee schedule rate for the corresponding procedure code. Therapy revenue codes are as follows:
- 042X for physical therapy
- 043X for occupational therapy
- 044X for speech therapy
The therapy corresponding procedure codes that are payable to CORF provider types can be found on the Comprehensive Outpatient Rehabilitation Facility (CORF)/Outpatient Rehabilitation Facility (ORF) Static Fee Schedule.
Next step for providers: Providers should follow the guidance as outlined in the policy and share this communication with their staff.
Resources:
Texas Medicaid Provider Procedure Manual: Section 6: Claims Filing
https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2023/2023-12-december/1_06_Claims_Filing_0.pdf
Texas Medicaid Provider Procedure Manual: Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook
https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2023/2023-12-december/2_16_PT_OT_ST_Srvs_0.pdf
TMHP Static Fee Schedules
https://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
