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Inpatient rehabilitation review choice — official procedure references

IRF review choice has pre-claim and postpayment pathways. Current state rollout and January 2027 MAC-J expansion are separate phases; physical state alone is insufficient for future scope. State rollout dates in the reviewed materials are Alabama August 21, 2023; Pennsylvania June 17, 2024; Texas March 2, 2026; and California May 1, 2026. A separate CMS announcement expands the demonstration to facilities billing MAC Jurisdiction J from January 1, 2027, regardless of physical state. The later announcement supplies the J expansion date; it does not establish dates for other jurisdictions. The review pathway and billing jurisdiction must be checked separately from patient residence. Preadmission screening timing: Screen within 48 hours immediately before admission and document rehabilitation physician concurrence before admission. Plan of care timing: Complete the plan of care within the first four admission days, including expected therapy intensity, frequency and duration. Preclaim and postpayment documentation differ: Plan-of-care and interdisciplinary-team documents may not yet exist at preclaim submission; the checklist separately identifies postpayment documentation requirements. These administrative timing and program-scope references do not establish that a patient satisfies home health or rehabilitation coverage criteria, and are not a professionally reviewed preparation checklist. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.
PayerCMS / Medicare
Plan contextOriginal Medicare — reference context only
ServiceInpatient rehabilitation review choice
State scopeNot verified
Effective dateNot verified
RevisionSource 1e372debe1f1
Retrieved10/15/2026
EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

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This public reference is available in full above. Paid research tools are not currently available; no clinical checklist or cross-payer authorization determination is included.

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Evidence fingerprint: 1e372debe1f1493577601a28a1738c2a23859a919115fd712d0f3ce1cf6bcc8c