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What are Physical Therapy Medicare G-Codes and How Do You Score a Patient?

If you are new to G-codes, the best way to describe them is as quality data codes that rehab therapy providers (including physical therapists, occupational ones and speech-language pathologists) include on their Medicare claim forms to fulfill the requirements for the Functional Limitation Reporting (FLR).

Functional Limitation Reporting, on the other hand, is a CMS reporting regulation for physical therapists, occupational ones and speech-language pathologists who provide outpatient therapy services to Medicare beneficiaries. The goal here is to establish an evidence-based connection between rehab therapy treatment and patient progress.

The sets of G-codes for FLR are unique - and CMS uses the sets of them to track information about the Medicare beneficiaries’ function and condition. Below, we are listing all of the 42 available FLR G-codes organized by category and specialty, followed by a list of (70) modifiers and therapy modifiers.

Mobility: Walking & Moving Around

G-Code

Description

                               Short Descriptor               

                                  G8978 Mobility       

Walking and moving around functional limitation, current status, at therapy episode outset, and at reporting intervals.

Mobility current status

G8979 Mobility

Walking and moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting.

Mobility goal status

G8980 Mobility

Walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting.

Mobility discharge status

 

Changing & Maintaining Body Position

G-Code

Description

                                     Short Descriptor         

           G8981            

Changing and maintaining body position functional limitation, current status, at therapy episode outset, and at reporting intervals.

Body position current status

G8982

Changing and maintaining body position functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reporting.

Body position goal status

G8983

Changing and maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting.

Body position discharge status

 

Carrying, Moving & Handling Objects

G-Code

Description

Short Descriptor

G8984

Carrying, moving, and handling objects functional limitation, current status, at therapy episode, and at reporting intervals

Carry current status

G8985

Carrying, moving, and handling objects functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

Carry goal status

G8986

Carrying, moving, and handling objects functional limitation, discharge status, at discharge from therapy or to end reporting

Carry discharge status

 

Self Care

G-Code

Description

Short Descriptor

G8987

Self care functional limitation, current status, at therapy episode outset, and at reporting intervals.

Self care current status

G8988

Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Self care goal status

G8989

Self care functional limitation, discharge status, at discharge from therapy or to end reporting

Self care discharge status

Other PT/OT Primary Functional Limitation

G-Code

Description

Short Descriptor

G8990

Other physical or occupational primary functional limitation, current status, at therapy episode outset, and at reporting intervals

Other PT/OT current status

G8991

Other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

Other PT/OT goal status

G8992

Other physical or occupational primary functional limitation, discharge status, at discharge from therapy to end reporting

Other PT/OT discharge status

Other PT/OT Subsequent Functional Limitation

G-Code

Description

Short Descriptor

G8993

Other physical or occupational subsequent functional limitation, current status, at therapy episode outset, and at reporting intervals

Sub PT/OT current status

G8994

Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Sub PT/OT goal status

G8995

Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reporting

Sub PT/OT discharge status

Speech-Language Pathology G-Codes

Swallowing

G-Code

Description

Short Descriptor

G8996

Swallowing functional limitation, current status, at therapy episode outset, and at reporting intervals

Swallow current status

G8997

Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Swallow goal status

G8998

Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting

Swallow discharge status

Motor Speech

G-Code

Description

Short Descriptor

G8999

Motor speech functional limitation, current status, at therapy episode outset, and at reporting intervals

Motor speech current status

G9186

Motor speech functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Motor speech goal status

G9158

Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting

Motor speech discharge status

Spoken Language Comprehension

G-Code

Description

Short Descriptor

G9159

Spoken language comprehension functional limitation, current status, at therapy episode outset, and at reporting intervals

Spoken language comprehension current status

G9160

Spoken language comprehension functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Spoken language comprehension goal status

G9161

Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting

Spoken language comprehension discharge status

Spoken Language Expression

G-Code

Description

Short Descriptor

G9162

Spoken language expression functional limitation, current status, at therapy episode outset, and at reporting intervals

Spoken language expression current status

G9163

Spoken language expression functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Spoken language expression goal status

G9164

Spoken language expression functional limitation, discharge status, at discharge from therapy or to end reporting

Spoken language expression discharge status

Attention

G-Code

Description

Short Descriptor

G9165

Attention functional limitation, current status, at therapy episode outset, and at reporting intervals

Attention current status

G9166

Attention functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Attention goal status

G9167

Attention functional limitation, discharge status, at discharge from therapy or to end reporting

Attention discharge status

Memory

G-Code

Description

Short Descriptor

G9168

Memory functional limitation, current status, at therapy episode outset, and at reporting intervals

Memory current status

G9169

Memory functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Memory goal status

G9170

Memory functional limitation, discharge status, at discharge from therapy or to end reporting

Memory discharge status

Voice

G-Code

Description

Short Descriptor

G9171

Voice functional limitation, current status, at therapy episode outset, and at reporting intervals

Voice current status

G9172

Voice functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Voice goal status

G9173

Voice functional limitation, discharge status, at discharge from therapy or to end reporting

Voice discharge status

Other Speech-Language Pathology

G-Code

Description

Short Descriptor

G9174

Other speech-language pathology functional limitation, current status, at therapy episode outset, and at reporting intervals

Other speech-language pathology current status

G9175

Other speech-language pathology functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting

Other speech-language pathology goal status

G9176

Other speech-language pathology functional limitation, discharge status, at discharge from therapy or to end reporting

Other speech-language pathology discharge status

Functional Limitation Severity Modifier Codes

Modifier

Impairment Limitation Restriction

CH

0% impaired, limited, or restricted

CI

At least 1% but less than 20% impaired, limited, or restricted

CJ

At least 20% but less than 40% impaired, limited, or restricted

CK

At least 40% but less than 60% impaired, limited, or restricted

CL

At least 60% but less than 80% impaired, limited, or restricted

CM

At least 80% but less than 100% impaired, limited, or restricted

CN

100% impaired, limited, or restricted

Functional Limitation Therapy Modifier Codes

Therapy modifiers indicate the type of therapy service you’re providing.

Modifier

Services Delivered Under Outpatient POC

GO

Occupational Therapy

GP

Physical Therapy

GN

Speech-Language Pathology

 

If you are a practice that sees Medicare patients or Medicare HMOs, it is super important to know how and when using G-codes is appropriate.  If you use a EMR software, it is extremely helpful to have these codes populate from the EMR into the billing software automatically.  As the provider, it allows me to know that the functional deficits I am seeing with a patient translates directly into the billing.  With www.HENO.io it is a simple process and makes my job as the PT so much easier!

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