Which IRF patients need an IRF-PAI?

All of them. CMS originally required it for Medicare Part A fee-for-service and Medicare Part C patients, but since October 1, 2024, IRFs must complete the IRF-PAI for every patient regardless of payer.

What changed in IRF-PAI version 4.4?

Version 4.4 took effect October 1, 2026, replacing version 4.2. CMS posts the 4.4 manual, published April 7, 2026, with a change table listing item and guidance changes, along with consolidated quarterly Q&As from June 2020 through June 2025.

Is the IRF-PAI the same as Form CMS-10036?

CMS-10036 is the number CMS lists for the IRF-PAI, but its forms list still links an obsolete 3-page 2006 edition. The current 30-page version 4.4 instrument, posted on the IRF-PAI manual page, no longer prints the CMS-10036 number.

IRF-PAI v4.4: Inpatient Rehab Patient Assessment

Who completes it

IRF clinicians who assess the patient, including rehabilitation nurses, therapists and physicians, complete the items. The patient does not fill in any part.

Submitting and payment

How to submit it: The IRF records the assessment in its EHR or vendor software and transmits it electronically to CMS through iQIES. The PDF is the item set for reference.
Who pays: IRF-PAI data set the patient's case-mix classification, which determines Medicare payment under the IRF prospective payment system.

Good to know

Since October 1, 2024, the IRF-PAI must be completed for all IRF patients regardless of payer, not only Medicare Part A and Medicare Advantage patients.
The IRF-PAI Manual v4.4, published April 7, 2026, gives item-by-item coding instructions and examples; a change table lists differences from v4.2.
A December 2025 errata revised falls items J1750, J1800 and J1900, including the definition of major injury, effective January 1, 2026.
The CMS forms list still links an obsolete 3-page Form CMS-10036 (01/06). The current instrument shows OMB 0938-0842, expiration 10/31/2027.

Get the official form

Download the current version from the source each time; forms change without notice.

Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI)

Official page PDF

All Medicare forms

CMS-485

Home Health Certification and Plan of Care

Certifies a Medicare patient's homebound status and need for skilled home health care and sets out the plan of care (orders, diagnoses, goals) for the certification period.

Completed by: Home health agency drafts it; the certifying physician or allowed practitioner (NP, CNS, PA) reviews, signs and dates it
Issued by: Centers for Medicare & Medicaid Services (CMS)
Format: PDF
Language: English

Official page PDF How to fill it in

CMS-R-131

Advance Beneficiary Notice of Non-coverage (ABN)

Aviso anticipado de no cobertura para el beneficiario (ABN)

Warns an Original Medicare patient before a service that Medicare may not pay, so the patient can choose to receive it and accept financial liability.

Completed by: Physician practice, supplier, lab, hospital outpatient, hospice or HHA staff (notifier)
Issued by: Centers for Medicare & Medicaid Services (CMS)
Format: Fillable PDF
Language: English and Spanish

Official page How to fill it in

Physician Certification Statement (PCS) for Non-Emergency Ambulance Transport

Certifies that a Medicare patient's non-emergency ambulance transport (scheduled, repetitive or unscheduled) is medically necessary because other transport is contraindicated.

Completed by: Attending physician (repetitive scheduled transports); for unscheduled transports a PA, NP, CNS, RN or discharge planner may sign
Issued by: Centers for Medicare & Medicaid Services (CMS)
Format: Sent for each case
Language: English

Official page Form details

Statement of Certifying Physician for Therapeutic Shoes

Certifies that a patient with diabetes has a qualifying foot condition and is under a comprehensive diabetes plan of care, so Medicare covers depth or custom-molded shoes and inserts.

Completed by: Certifying physician managing the diabetes (must be an MD or DO)
Issued by: DME MACs (CGS Administrators JB/JC; Noridian JA/JD), hosted in the CMS Medicare Coverage Database (LCD L33369 attachment)
Format: PDF
Language: English

Official page PDF How to fill it in

MDS 3.0

Minimum Data Set (MDS) 3.0 Resident Assessment Instrument Item Sets

Standard clinical assessment of every resident of a Medicare/Medicaid-certified nursing home or swing bed, used for care planning, SNF PPS (PDPM) payment and quality measures.

Completed by: Nursing home interdisciplinary team, coordinated and signed by the RN assessment coordinator
Issued by: Centers for Medicare & Medicaid Services (CMS)
Format: Online portal or EMR
Language: English

Official page Form details

OASIS-E2

Outcome and Assessment Information Set (OASIS-E2) All Items

Standard comprehensive assessment of Medicare/Medicaid home health patients at start of care, resumption, follow-up, transfer and discharge, used for payment (PDGM case mix) and quality reporting.

Completed by: Home health agency registered nurse or therapist (PT, SLP, OT where permitted) performing the assessment visit
Issued by: Centers for Medicare & Medicaid Services (CMS)
Format: Online portal or EMR
Language: English

Official page PDF Form details

Get the note ready with Vero

Centers for Medicare & Medicaid Services (CMS) takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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