by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 16th, 2016
The following G-codes are used for reporting on claims for Medicare Part B and must be used with a severity/complexity modifier, the use of G-codes are enforced and required beginning Jan. 01, 2013, claims will be returned or rejected if they do not contain the required functional G-Code/modifier information.
There are 42 functional G-codes, 14 sets of three codes each. Six of the G-code sets generally describe PT and OT functional limitations, and eight sets of G-codes generally describe SLP functional limitations.
Only one functional limitation shall be reported at a given time for each related therapy plan of care (POC). However, functional reporting is required on claims throughout the entire episode of care; so, there will be instances where two or more functional limitations will be reported for one beneficiary’s POC, just not during the same time frame.
In these situations, where reporting on the first reported functional limitation is complete and the need for treatment continues, reporting is required for a second functional limitation using another set of G-codes. Thus, reporting on more than one functional limitation may be required for some beneficiaries, but not simultaneously.
Specifically, functional reporting, using the G-codes and modifiers, is required on therapy claims for certain DOS as described below:
• At the outset of a therapy episode of care, i.e., on the DOS for the initial therapy service;
• At least once every 10 treatment days -- which is the same as the newly-revised progress reporting period -- the functional reporting is required on the claim for services on same DOS that the services related to the progress report are furnished;
• The same DOS that an evaluative procedure, including a re-evaluative one, is submitted on the claim (see below for applicable HCPCS/CPT codes);
• At the time of discharge from the therapy episode of care, if data is available; and,
• On the same DOS the reporting of a particular functional limitation is ended, in cases where the need for further therapy is necessary. As noted above, this functional reporting coincides with the progress reporting frequency, which is being changed through this instruction. Previously, the progress reporting was due every 10th treatment day or 30 calendar days, whichever was less. The new requirement is for the services related to the progress reports to be furnished on or before every 10thtreatment day.
In the example below, the G-codes for the mobility functional limitation (G8978 -8980) are used to illustrate the timing of the functional reporting.
- At the outset of therapy-- the DOS the evaluative procedure is billed or the initial therapy services are furnished:
G8978 and G8979, along with the related severity modifiers, are used to report the current status and projected goal status of the mobility functional limitation.
- At the end of each progress reporting period --the DOS when the progress report services are furnished: oG8978 and G8979, along with the related severity modifiers, are used to report the current status and projected goal status of the mobility functional limitation.
This step is repeated as clinically appropriate
- At the time the beneficiary is discharged from the therapy episode -- the DOS the discharge progress report services are furnished
G8979 and G8980, along with the related severity modifiers, are used to report the projected goal and discharge status of the mobility functional limitation.
In the above example, if further therapy is medically necessary once reporting for the mobility functional limitation has ended, the therapist begins reporting on another functional limitation using a different set of G-codes.
Reporting of the next functional limitation is required on the DOS of the first treatment day after the reporting was ended for the mobility functional limitation
Mobility Status
G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals
G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting
Changing & Maintaining Body Position Status
G8981 Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals
G8982 Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8983 Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
Carrying, Moving & Handling Objects Status
G8984 Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
G8985 Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8986 Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
Self Care Status
G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals
G8988 Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8989 Self care functional limitation, discharge status, at discharge from therapy or to end reporting
Other Physical or Occupational Therapy Status
G8990 Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals
G8991 Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8992 Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting
Subsequent Physical or Occupational Therapy Status
G8993 Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
G8994 Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8995 Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
Swallowing Status
G8996 Swallowing functional limitation, current status at therapy episode outset and at reporting intervals
G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
Motor Speech Status
G8999Motor speech functional limitation, current status at therapy episode outset and at reporting intervals
G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
G9186Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
Spoken Language Comprehension Status
G9159 Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals
G9160 Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
Spoken Language Expressive Status
G9162 Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals
G9163 Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9164 Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting
Attention Status
G9165 Attention functional limitation, current status at therapy episode outset and at reporting intervals
G9166 Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9167 Attention functional limitation, discharge status at discharge from therapy or to end reporting
Memory Status
G9168 Memory functional limitation, current status at therapy episode outset and at reporting intervals
G9169 Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9170 Memory functional limitation, discharge status at discharge from therapy or to end reporting
Voice Status
G9171 Voice functional limitation, current status at therapy episode outset and at reporting intervals
G9172 Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9173 Voice functional limitation, discharge status at discharge from therapy or to end reporting
Other Speech Language Pathology Status
G9174 Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals
G9175 Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting
G9176 Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting
HCPCS code G0152 (services of occupational therapist in home health setting, each 15 minutes) is the only required HCPCS code in home health. All others are for informational purposes only.
For each of the above-listed non payable G-codes , a modifier must be used to report the severity/complexity for that functional measure. The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the therapist, physician, or NPP furnishing the therapy services. The beneficiary’s current status, the anticipated goal status, and the discharge status are reported via the appropriate severity modifiers. The seven severity modifiers are defined below:
Modifier Impairment Limitation Restriction
CH 0 percent impaired, limited or restricted
CI At least 1 percent but less than 20 percent impaired, limited or restricted
CJ At least 20 percent but less than40 percent impaired, limited or restricted
CK At least 40 percent but less than 60 percent impaired, limited or restricted
CL At least 60 percent but less than 80 percent impaired, limited or restricted
CM At least 80 percent but less than 100 percent impaired, limited or restricted
CN 100 percent impaired, limited or restricted
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