What are G-Codes?

G-codes are quality data codes that rehab therapy providers—including eligible physical therapists, occupational therapists, and speech-language pathologists—include on their Medicare claim forms to fulfill requirements for Physician Quality Reporting System (PQRS) and Functional Limitation Reporting (FLR). Although, the G-codes for PQRS and FLR are different and distinct, CMS uses both sets of codes to track information about Medicare beneficiaries’ function and condition.

Effective January 1, 2017, rehab therapists no longer have to report G-codes for Physician Quality Reporting System (PQRS), as that quality-reporting program sunsetted at the end of 2016.

Below is a comprehensive list of the 42 available FLR G-codes organized by category and specialty, followed by a list of severity modifiers and therapy modifiers. Further down the page, you’ll find the full list of G-codes for the PQRS program, which, as noted above, is no longer in effect.

What are Functional Limitation Reporting G-Codes?

First off, let’s cover some FLR basics. Functional Limitation Reporting is a Centers for Medicare & Medicaid Services (CMS) reporting regulation for physical therapists, occupational therapists, and speech-language pathologists who provide outpatient therapy services to Medicare beneficiaries. Medicare will not reimburse providers for claims lacking FLR data.

The goal of FLR is to establish an evidence-based connection between rehab therapy treatment and patient progress. CMS uses the information it collects to get a better sense of the Medicare beneficiary population and to evaluate the effectiveness of the therapy treatment this group is receiving. The FLR data pool also is meant to help CMS reform future payment structures.

Completing FLR

To comply with FLR, therapists must report functional limitation data in the form of G-codes—along with the corresponding severity modifiers and therapy modifiers—at the initial examination, at minimum every tenth visit (or progress note), and at discharge for all patients who have Medicare proper as their primary or secondary insurance. Therapists do not need to complete FLR for patients who have Medicare replacement or Advantage plans.

You only may report functional limitation data on each patient's’ primary functional limitation—in other words, the main reason he or she sought your rehabilitative services. However, you may—and should—continue treating as many limitations as appropriate.

Your documentation and claim should include two FLR G-codes, each followed by a severity modifier and a therapy modifier, for a total of six FLR codes.

For an example of functional limitation reporting in action, check out this post.

Medicare Claim Form

You should submit FLR G-codes as separate line items on Medicare claims. First, enter the regular CPT codes as you normally would to indicate the treatment you’ve provided. Then, simply submit each G-code with a nominal charge ($0.00 for private practices and $0.01 for institutional settings). For claims that are longer than one page, enter the total for item 27 on the last CMS-1500 claim form.

Reimbursement

To ensure you receive proper reimbursement for your services, follow these simple tips from WebPT and compliance expert Tom Ambury:

  1. Create clear, detailed documentation during each patient’s episode of care.
  2. Audit your clinic’s documentation process regularly to ensure defensibility.
  3. File your claims in a timely manner.
  4. Stay current on reporting regulations, requirements, and legislation.
  5. Have a knowledgeable and trustworthy source for compliance information in case you have a question.

Rejections

If you’ve received a rejection letter in response to a claim you submitted because it was missing FLR data, there’s not much you can do—unless, of course, you’re in a situation in which you actually identified your patient’s primary functional limitation, completed an outcome measurement tool, and documented the resulting episode of care appropriately, but inadvertently omitted the corresponding G-codes and severity modifiers. If—and only if—this is the case, you may go back, create an addendum with the missing codes, and resubmit your claim. However, addendums could throw up red flags for Medicare. To learn more about the appropriateness of creating addendums in your specific situation, contact your local MAC or a compliance expert. Under no circumstances should you go back and change your documentation to simply meet FLR requirements.

Click here for comprehensive information on FLR, including an FAQ document, a ten-question quiz, and the Therapist’s Guide to Functional Limitation Reporting.

Now, on to the codes.

Physical Therapy and Occupational Therapy FLR G-Codes

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

What are FLR Outcome Measurement Tools?

Outcome measurement tools are objective tests that therapists use to help determine the severity and complexity of their patients’ functional limitations. Here are some of the outcome measurement tools that are available for rehab therapists:

Physical and Occupational Therapists

General Function Balance Lower Extremity Spine Upper Extremity
Barthel Index ABC Scale Lower Extremity Functional Scale Neck Disability Index Questionnaire DASH
Dynamic Gait Index Berg   Oswestry Low Back Pain Disability Questionnaire Hand Profile
Dizziness Handicap Inventory Fullerton Advanced Balance Sale   The Quebec Back Pain Disability Scale Shoulder Pain and Disability Questionnaire
Functional Reach Test Motion Sensitivity Score     Upper Extremity Functional Index
Mini Mental State Exam Tinetti     Upper Extremity Quick DASH
TUG        

Speech-Language Pathologists

Alaryngeal Communication
Attention
Augmentative-Alternative Communication
Fluency
Functional Communication Measures
Memory
Motor Speech
Pragmatics
Problem Solving
Reading
Spoken Language Comprehension
Spoken Language Expression
Swallowing
Voice
Writing
Voice Following Tracheostomy

Download the Therapists’ Guide to FLR now.

Access full G-code lists, documentation instructions, and functional limitation reporting examples in our PDF handbook. Enter your email address below, and we’ll send it your way.

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What were the Physician Quality Reporting System G-Codes?

Prior to the consolidation of PQRS into the Merit-based Incentive Payment System (MIPS) in January 2017, rehab therapists used a separate set of G-codes to report on PQRS measures. These G-codes were totally unrelated to those used for functional limitation reporting.

Below are the G-codes and other quality data codes (QDCs) that were associated with the 2016 PQRS measures applicable to each specialty (physical therapy, occupational therapy, and speech-language pathology).

Click here for more information about PQRS.

Physical Therapy

#126 Diabetes Foot/Ankle Evaluation

G8404: Lower extremity neurological exam performed and documented

G8405: Lower extremity neurological exam not performed

#127 Diabetes - Footwear Evaluation

G8410: Footwear evaluation performed and documented

G8416: Clinician documented that patient was not an eligible candidate for footwear evaluation measure

G8415: Footwear evaluation was not performed

#128 BMI Screening

G8420: BMI is documented within normal parameters and no follow-up plan is required

G8417: BMI is documented above normal parameters and a follow-up plan is documented

G8418: BMI is documented below normal parameters and a follow-up plan is documented

G8422: BMI not documented, documentation states that the patient is not eligible for BMI calculation

G8938: BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation states that the patient is not eligible

G8421: BMI not documented and no reason is given

G8419: BMI documented outside normal parameters, no follow-up plan documented, no reason given

#130 Current Medications

G8427: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications

G8430: Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional

G8428: Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given

#131 Pain Assessment

G8730: Pain assessment documented as positive using a standardized tool AND a follow-up plan is documented

G8731: Pain assessment using a standardized tool is documented as negative, no follow-up plan required

G8442: Pain assessment NOT documented as being performed, documentation states that the patient is not eligible for a pain assessment using a standardized tool

G8939: Pain assessment documented as positive, follow-up plan not documented, documentation states that the patient is not eligible

G8732: No documentation of pain assessment, reason not given

G8509: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given

#154 Falls Risk Assessment

CPT II 3288F AND 1100F: Falls risk assessment documented AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

CPT II 3288F-1P AND 1100F: Documentation of medical reason(s) for not completing a risk assessment for falls AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

CPT II 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only one fall without injury in the past year

CPT II 1101F-8P: No documentation of falls status

CPT II 3288F-8P AND 1100F: Falls risk assessment not completed, reason not otherwise specified AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

#155 Falls POC

CPT II 0518F: Falls plan of care documented

CPT II 0518F-1P: Documentation of medical reason(s) for no plan of care for falls

CPT II 0518F-8P: Plan of care not documented, reason not otherwise specified

#182 Functional Outcome Assessment

G8539: Functional outcome assessment documented as positive using a standardized tool AND a care plan based on identified deficiencies on the date of the functional outcome assessment is documented

G8542: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required

G8942: Functional outcome assessment using a standardized tool is documented within the previous 30 days and care plan based on identified deficiencies on the date of the functional outcome assessment is documented

G8540: Functional outcome assessment NOT documented as being performed, documentation states that the patient is not eligible for a functional outcome assessment using a standardized tool

G9227: Functional outcome assessment documented, care plan not documented, documentation states that the patient is not eligible for a care plan

G8541: Functional outcome assessment using a standardized tool not documented, reason not given

G8543: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given

Occupational Therapy

#128 BMI Screening

G8420: BMI is documented within normal parameters and no follow-up plan is required

G8417: BMI is documented above normal parameters and a follow-up plan is documented

G8418: BMI is documented below normal parameters and a follow-up plan is documented

G8422: BMI not documented, documentation states that the patient is not eligible for BMI calculation

G8938: BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation states that the patient is not eligible

G8421: BMI not documented and no reason is given

G8419: BMI documented outside normal parameters, no follow-up plan documented, no reason given

#130 Current Medications

G8427: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications

G8430: Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional

G8428: Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given

#131 Pain Assessment

G8730: Pain assessment documented as positive using a standardized tool AND a follow-up plan is documented

G8731: Pain assessment using a standardized tool is documented as negative, no follow-up plan required

G8442: Pain assessment NOT documented as being performed, documentation states that the patient is not eligible for a pain assessment using a standardized tool

G8939: Pain assessment documented as positive, follow-up plan not documented, documentation states that the patient is not eligible

G8732: No documentation of pain assessment, reason not given

G8509: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given

#134 Preventative Clinical Depression Screening

G8431: Screening for clinical depression is documented as being positive AND a follow-up plan is documented

G8510: Screening for clinical depression is documented as negative, a follow-up plan is not required

G8433: Screening for clinical depression not documented, documentation stating the patient is not eligible

G8940: Screening for clinical depression documented as positive, a follow-up plan not documented, documentation stating the patient is not eligible

G8432: Clinical depression screening not documented, reason not given

G8511: Screening for clinical depression documented as positive, follow-up plan not documented, reason not given

#154 Falls Risk Assessment

CPT II 3288F AND 1100F: Falls risk assessment documented AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

CPT II 3288F-1P AND 1100F: Documentation of medical reason(s) for not completing a risk assessment for falls AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

CPT II 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only one fall without injury in the past year

CPT II 1101F-8P: No documentation of falls status

CPT II 3288F-8P AND 1100F: Falls risk assessment not completed, reason not otherwise specified AND patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

#155 Falls POC

CPT II 0518F: Falls plan of care documented

CPT II 0518F-1P: Documentation of medical reason(s) for no plan of care for falls

CPT II 0518F-8P: Plan of care not documented, reason not otherwise specified

#181 Elder Maltreatment Screen and Follow-Up

G8733: Elder maltreatment screen documented as positive AND a follow-up plan is documented

G8734: Elder maltreatment screen documented as negative, follow-up is not required

G8535: Elder maltreatment screen not documented; documentation states that patient is not eligible for the elder maltreatment screen

G8941: Elder maltreatment screen documented as positive, follow-up plan not documented, documentation states that the patient is not eligible for follow-up plan

G8536: No documentation of an elder maltreatment screen, reason not given

G8735: Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given

#182 Functional Outcome Assessment

G8539: Functional outcome assessment documented as positive using a standardized tool AND a care plan based on identified deficiencies on the date of the functional outcome assessment is documented

G8542: Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required

G8942: Functional outcome assessment using a standardized tool is documented within the previous 30 days and care plan based on identified deficiencies on the date of the functional outcome assessment is documented

G8540: Functional outcome assessment NOT documented as being performed, documentation states that the patient is not eligible for a functional outcome assessment using a standardized tool

G9227: Functional outcome assessment documented, care plan not documented, documentation states that the patient is not eligible for a care plan

G8541: Functional outcome assessment using a standardized tool not documented, reason not given

G8543: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given

#226 Tobacco Use Screen and Cessation Intervention

CPT II 4004F: Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user

CPT II 1036F: Current tobacco non-user

4004F-1P: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy or other medical reasons)

4004F-8P: Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified

Speech-Language Pathology

#130 Current Medications

G8427: Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications

G8430: Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional

G8428: Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given

#131 Pain Assessment

G8730: Pain assessment documented as positive using a standardized tool AND a follow-up plan is documented

G8731: Pain assessment using a standardized tool is documented as negative, no follow-up plan required

G8442: Pain assessment NOT documented as being performed, documentation states that the patient is not eligible for a pain assessment using a standardized tool

G8939: Pain assessment documented as positive, follow-up plan not documented, documentation states that the patient is not eligible

G8732: No documentation of pain assessment, reason not given

G8509: Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given

#226 Tobacco Use Screen and Cessation Intervention

CPT II 4004F: Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user

CPT II 1036F: Current tobacco non-user

4004F-1P: Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy or other medical reasons)

4004F-8P: Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified

Do I still have to submit G-codes in 2017?

Because PQRS ended in December 2016, PTs, OTs, and SLPs no longer have to report this specific set of G-codes to meet quality-reporting requirements. However, eligible therapists still must submit FLR G-codes in order to avoid claim denials.


Don’t face Medicare compliance alone.


Heidi Jannenga

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