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 reporting?
CMS created FLR to collect information regarding beneficiaries’ functions and conditions, the services therapists provide, and the functional outcomes patients achieve. CMS will use all of this information to better understand the beneficiary population that uses therapy services and how their functional limitations change as a result of the therapy they complete. Furthermore, CMS will use the data they collect to reform future payment structures.

Does FLR apply to rehab therapists?
According to the APTA, “All practice settings that provide outpatient therapy services must perform FLR. Specifically, FLR applies to physical therapy, occupational therapy, and speech-language-pathology (SLP) services furnished in hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities (CORFs), rehabilitation agencies, home health agencies (when the beneficiary is not under a home health plan of care), and in private offices of therapists, physicians, and non-physician practitioners.”

How does FLR work?
Therapists will report functional limitations (current status and projected goal for initial examination and at minimum every tenth visit or progress note, and then discharge status and projected goal at discharge) using G-codes and corresponding severity modifiers for all eligible Medicare patients.

What are G-codes and severity modifiers?
G-codes are quality data codes therapists will use to describe their patients’ functional limitation—that is, the primary reason they’re seeking therapeutic services. Upon identifying the primary limitation, the therapist will select the corresponding G-code and then assign a severity modifier, which indicates the extent of the severity of the functional limitation. Therapists select an appropriate severity modifier based on the score of an outcome measurement tool as well as their skilled clinical knowledge. Lastly, therapists must also include a therapy modifier (GO, GP, and GN) to indicate that they’re providing therapy services under an OT, PT, or SLP plan of care, respectively. 

For a full list of the FLR G-codes and a severity modifier chart, check out this blog post.

Want to really learn your stuff?
Head to FunctionalLimitation.org and watch our super detailed FLR webinar, download our ultimate guide, and take a quiz. Additionally, stay tuned to our blog this month, because we’ll post a myriad of helpful FLR articles as well as details about WebPT’s new fully integrated FLR feature.

Medicare Open Forum - Regular BannerMedicare Open Forum - Small Banner
  • 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 …

  • Most Frequently Asked Questions From Our Functional Limitation Reporting Webinars Image

    articleMay 22, 2013 | 12 min. read

    Most Frequently Asked Questions From Our Functional Limitation Reporting Webinars

    Today's blog post comes from WebPT Senior Writer Charlotte Bohnett, contributing writer Erica Cohen, and WebPT Co-Founder Heidi Jannenga, PT. Monday and Tuesday we hosted webinars on functional limitation reporting. We got tons of great questions. Here are the most frequently asked ones: The Basics What is functional limitation reporting? Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare part B patients in order to receive reimbursement for your …

  • articleNov 7, 2013 | 2 min. read

    FLR and PQRS: How Are They Different?

    Functional limitation reporting (FLR) and PQRS both fall under the ever-widening umbrella of Medicare regulations, and they both involve outcome measures and data codes. Still, they are completely separate requirements, each with its own set of rules. Confusing, we know. To help you sort out the differences, we’ve put together a short breakdown of each one as well as a detailed compare/contrast chart: The Basics of FLR On July 1, 2013, Centers for Medicare & Medicaid Services …

  • Functional Outcome Measures Image

    articleNov 28, 2012 | 5 min. read

    Functional Outcome Measures

    Today's post comes from Tom Ambury, PT and compliance officer at  PT Compliance Group , based off this month’s “Compliance Chat” blog post . By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny …

  • 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 …

  • PQRS 2016 Measures Image

    articleNov 19, 2015 | 1 min. read

    PQRS 2016 Measures

    While PQRS measures specifications won’t be available until December, we do know which measures are available for 2016. Here’s the breakdown by specialty: Physical Therapy #126 Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation #127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear #128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up #130 Documentation of Current Medications in the Medical Record #131 Pain Assessment and …

  • articleNov 5, 2013 | 3 min. read

    Founder Letter: PQRS 2014

    Well, it’s November already, and that means two things: Thanksgiving and Physician Quality Reporting System (PQRS). Sure, PQRS doesn’t involve mouthwatering roasted turkey, savory stuffing, or creamy mashed potatoes, but it has become quite the November tradition for us here at WebPT. You see, this is the time of year that the Centers for Medicare & Medicaid Services (CMS) typically confirms the details of next year’s reporting requirements, thus allowing us to update our PQRS solution (claims- …

  • webinarMay 21, 2013

    Get Ready for Functional Limitation Reporting

    Beginning July 1, 2013, CMS is requiring that you complete functional limitation reporting (FLR) on all Medicare patients in order to receive reimbursement for your services. We know you want to get paid. That’s why it’s crucial you have functional limitation reporting down pat. With that in mind, WebPT will host a special webinar on May 20 to help you get fully prepared for FLR. In this 60-minute session, hosts Heidi Jannenga and Mike Manheimer will explain …

  • Functional Limitation Reporting Refresher Image

    articleDec 12, 2016 | 4 min. read

    Functional Limitation Reporting Refresher

    The rehab therapy industry is abuzz with PQRS talk right now. In case you missed it: PQRS as it exists today is dunzo . In 2017, it’ll be replaced with the Merit-Based Incentive Payment System , or MIPS. Unfortunately, though—and yes, it is unfortunate —PTs, OTs, and SLPs are not required to complete MIPS reporting until 2019. (And the jury is still out as to whether they’ll be able to voluntarily participate before then.) All outpatient rehab …

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