We’ve covered the ins and outs of G-codes as well as how it easy it will be to implement them successfully within WebPT—and why an integrated functional limitation reporting solution is the best solution. Today let’s go back to the G-code basics.

What’s a G-code?

Effective July 1, 2013, CMS will require therapists to complete functional limitation reporting through the use of new G-codes and corresponding severity modifiers for all eligible Medicare patients at the initial examination, at minimum every ten visit (or progress note), and at discharge in order to receive reimbursement.

Which G-Codes should I use?

Here are the 42 new G-codes you can use to describe your patients’ primary functional limitation:

Mobility: Walking & Moving Around

  • G8978 Mobility: walking and moving around functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Mobility goal status
  • G8980 Mobility: walking and moving around functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Mobility discharge status

Changing & Maintaining Body Position

  • G8981 Changing and maintaining body position functional limitation, current status, at therapy episode outset, and at reporting intervals
    • Short descriptor: Body pos 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
    • Short descriptor: Body pos goal status
  • G8983 Changing and maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Body pos discharge status

Carrying, Moving & Handling Objects

  • G8984 Carrying, moving, and handling objects functional limitation, current status, at therapy episode and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Carry goal status
  • G8986 Carrying, moving, and handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Carry discharge status

Self Care

  • G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals.
    • Short descriptor: Self care current status
  • G8988 Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at at discharge or to end reporting
    • Short descriptor: Self care goal status
  • G8989 Self care functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Self care discharge status

Other PT/OT Primary Functional Limitation

  • G8990 Other physical or occupational primary functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Other PT/OT goal status
  • G8992 Other physical or occupational primary functional limitation, discharge status, at discharge from therapy to end reporting
    • Short descriptor: Other PT/OT discharge status

Other PT/OT Subsequent Functional Limitation

  • G8993 Other physical or occupation subsequent functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Sub PT/OT goal status
  • G8995 Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Sub PT/OT discharge status

Swallowing

  • G8996 Swallowing functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Swallow current status
  • G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Swallow goal status
  • G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Swallow discharge status

Motor Speech

  • G8999 Motor speech functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Motor speech goal status
  • G9158 Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Motor speech discharge status

Spoken Language Comprehension

  • G9159 Spoken language comprehension functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Spoken language comprehension goal status
  • G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Spoken language comprehension discharge status

Spoken Language Expression

  • G9162 Spoken language expression functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Spoken language expression goal status
  • G9164 Spoken language expression functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Spoken language expression discharge status

Attention

  • G9165 Attention functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Attention current status
  • G9166 Attention functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Attention  goal status
  • G9167 Attention functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Attention discharge status

Memory

  • G9168 Memory functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Memory current status
  • G9169 Memory functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Memory goal status
  • G9170 Memory functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Memory discharge status

Voice

  • G9171 Voice functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: Voice current status
  • G9172 Voice functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reporting
    • Short descriptor: Voice goal status
  • G9173 Voice functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Voice discharge status

Other Speech Language Pathology

  • G9174 Other speech language pathology functional limitation, current status, at therapy episode outset and at reporting intervals
    • Short descriptor: 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
    • Short descriptor: Other speech language pathology goal status
  • G9176 Other speech language pathology functional limitation, discharge status, at discharge from therapy or to end reporting
    • Short descriptor: Other speech language pathology discharge status

What are the Severity Modifiers?

With each G-code, use one of the following modifiers (in a seven point scale) to report the severity and complexity for that functional limitation. You base this assessment on the score of an outcome measurement tool as well as your skilled clinical knowledge as a therapist.

 

2013 Functional Limitation Severity Modifiers

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

 

In addition to reporting these new G-codes and modifiers, you must also include the therapy modifiers (GO, GP, and GN) to indicate that the therapy services are furnished under an OT, PT, or SLP plan of care, respectively.

Want more info? Check out our free functional limitation webinar here.

Physical Therapy Billing Open Forum - Regular BannerPhysical Therapy Billing Open Forum - Small Banner
  • articleJan 3, 2013 | 2 min. read

    Now That I Know G-Codes Ain’t No Thang, How Do I Implement ‘Em?

    Last month, we discussed CMS’s new G-codes in a cleverly titled post, “ Ain’t Nothin’ But a G-Code, Baby. ” As the name implies, this new functional limitation reporting mandate is not nearly as daunting as you may think. In fact, if you use WebPT, it’s going to be as easy as pie—cherry pie, or maybe apple. Regardless, I digress. Here, we’ll discuss how with just a few clicks, and some clinical judgment, you can easily implement …

  • How to Complete Functional Limitation Reporting in WebPT Image

    articleFeb 19, 2014 | 4 min. read

    How to Complete Functional Limitation Reporting in WebPT

    As of July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) requires that therapists complete functional limitation reporting (FLR)—through the use of  G-codes and severity modifiers —on all eligible Medicare Part B patients at the initial evaluation, re-evaluation if applicable, every progress note (minimum of every ten visits), and discharge in order to receive reimbursement for their services. Today, several other private insurance companies also require FLR data as a condition of reimbursement. Good thing …

  • articleMar 11, 2013 | 17 min. read

    February Medicare Webinar Q&A

    Last month’s webinar on Medicare was our most highly attended webinar to date. And that’s really not surprising, because wherever Medicare goes, questions follow. But unfortunately, we couldn’t get to them all live. So we thought we’d put together a blog post will all the great questions you asked and our answers. That way, you can access it wherever, whenever you want. Ready to jump in? Here’s your Medicare Q&A.    (P.S. Are you a first timer …

  • Ain’t Nothin’ But a G-Code, Baby. What You Need to Know About the New G-Codes. Image

    articleAug 20, 2017 | 6 min. read

    Ain’t Nothin’ But a G-Code, Baby. What You Need to Know About the New G-Codes.

    Like the ’90s hip-hop-themed title of this blog post implies, Functional Limitation Reporting G-codes may be new, but they’re nothing to fret over. Essentially, effective July 1, 2013, CMS began requiring therapists to report new G-codes in an effort to further emphasize function and functional progress in therapy treatment. But the good news is that you should already be assessing—and documenting—functional progress as part of your short- and long-term goal setting at the initial evaluation, tenth visit …

  • Common Questions from our G-Code Denials Webinar: Part 1 Image

    articleJul 29, 2014 | 6 min. read

    Common Questions from our G-Code Denials Webinar: Part 1

    Today’s blog post comes from WebPT writers Brooke Andrus and Erica Cohen. If a patient has more than one functional limitation associated with a single diagnosis, should I report G-codes and severity modifiers for all of them? No. Medicare will only accept functional limitation reporting (FLR) data for one primary functional limitation per case. Therefore, if the patient has multiple functional limitations associated with a single diagnosis, you'll need to determine which one represents the patient's primary …

  • The Basics of Functional Limitation Reporting Image

    articleMay 2, 2013 | 3 min. read

    The Basics of Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on Medicare part B patients in order to receive reimbursement for your services. While WebPT can monumentally help with this task through our soon-to-be-released integrated functional limitation reporting feature, it’s important that you still understand FLR thoroughly, especially because clinical judgment does play a large role in its completion. So, with that in mind, let’s tackle the basics of FLR. Why functional limitation …

  • articleJun 27, 2013 | 6 min. read

    Functional Limitation Reporting and You: What You Need to Know

    Wow, can July 1 really be right around the corner? Seems like yesterday we were only finding out about the requirement to document and report functional limitation G-codes and severity/complexity modifiers, and I think it really was only yesterday that CMS figured out how they would work. Let me start by making sure you understand that functional limitation reporting (FLR) and PQRS are separate and distinct programs and that each program has its own set of codes …

  • articleNov 6, 2013 | 2 min. read

    Functional Limitation Reporting in a Nutshell

    Hopefully, you’ve been working your functional limitation reporting (FLR) magic for months now, so you’ve got it down pat. If not, you’re probably running into more than your fair share of claim denials. Don’t worry; we’re here to help. Here are some FLR basics in a convenient chestnut shell. (It is almost that time of the year , after all). What is FLR? Beginning July 1, 2013, the Centers for Medicare and Medicaid Services (CMS) require that …

  • Common Questions from our G-Code Denials Webinar: Part 2 Image

    articleJul 30, 2014 | 4 min. read

    Common Questions from our G-Code Denials Webinar: Part 2

    I heard that some private insurance carriers are now requiring functional limitation reporting. Is this true? Some non-Medicare insurers do require functional limitation reporting (e.g., Texas Workers' Compensation). Check out this blog post to see a list of the ones we know about right now. Keep in mind, however, that this list is ever-changing—so if you’re unsure of whether a particular plan requires FLR, be sure to inquire directly with the carrier. If I did not submit …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.