As of July 1, 2013, the Centers for Medicare and Medicaid Services requires that all practice settings providing outpatient therapy services—and billing for those services under Medicare Part B—complete functional limitation reporting (FLR) on all eligible Medicare patients in order to receive reimbursement for their services. From the initial whispers of FLR, we’ve explained that private payers will most likely follow Medicare’s lead, and indeed they have.

In the months since FLR became mandatory, a handful of private health plans have started requiring FLR. It’s important to note, though, the majority of private carriers do not currently require FLR. Below is a list of insurance plans that currently require FLR, but keep in mind that this list is ever-changing. If you’re unsure of whether a particular plan requires FLR, be sure to inquire directly with the carrier.

  • Blue Cross Blue Shield (BCBS) Medicare Advantage (Minnesota and Idaho)
  • Medica Medicare Advantage (Minnesota)
  • Anthem BCBS
  • Today’s Options and Amerigroup (New York)
  • Amerigroup Medicare Advantage (New Mexico, Texas, Tennessee, Florida, Maryland, New Jersey, and New York)
  • Highmark (Pennsylvania, West Virginia, and Delaware)
  • Soundpath Health (Washington)
  • WellCare, Freedom Healthcare, AARP, CarePlus, and Physicians United (Florida)
  • Geisinger Gold Medicare
  • Coventry
  • Texas Workers’ Compensation
  • The Veterans Administration
  • Health Net Medicare Advantage
  • MVP Gold

In preparation of other payers adopting this Medicare requirement, we designed our integrated FLR tool to work for all insurances. WebPT Members simply need to turn it on for any plans to which they’d like to report functional limitation G-codes and modifiers. To do so, select the insurance you’d like to edit within our application, and then check the box next to “Apply Functional Limitation Reporting,” as shown in the screenshot example below.

As other private payers jump on the FLR bandwagon, we’ll keep you informed both on our blog and on functionallimitation.org, a site dedicated entirely to FLR. Things in healthcare reform can change overnight, though, so to reiterate our abovementioned recommendation, if you’re ever unsure of whether a particular plan requires FLR, please inquire with that specific carrier.

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