Introduction
What were G-codes?
G-codes were quality data codes that rehab therapy providers—including eligible physical therapists, occupational therapists, and speech-language pathologists—included on their Medicare claim forms to fulfill requirements for Functional Limitation Reporting (FLR). CMS originally used this code set to track information about Medicare beneficiaries’ function and condition. G-codes were also used to report for PQRS—a defunct quality-reporting program—until January 1, 2017.
Effective January 1, 2019, providers no longer have to report G-codes or severity modifiers for Medicare FLR. CMS eliminated all Medicare FLR requirements in the 2019 physician fee schedule, stating that the program placed undue burden on participants. To avoid billing mishaps, Medicare made FLR optional during 2019, but it is now no longer a requirement for outpatient rehab therapists.
Below is a comprehensive list of the 42 G-codes used in FLR (organized by category and specialty), followed by a list of now-discontinued severity modifiers, and still-active 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 Further down the page, you’ll find the full list of G-codes for the PQRS program, which, as noted above, is no longer in effect.
(Please note, these G-codes are not to be confused with GG codes, which are still used in post-acute rehab settings such as home health and skilled nursing facilities.)
What were functional limitation reporting G-codes?
First off, let’s cover some FLR basics. Functional Limitation Reporting was a Centers for Medicare & Medicaid Services (CMS) reporting regulation for physical therapists, occupational therapists, and speech-language pathologists who provided outpatient therapy services to Medicare beneficiaries. Medicare would not reimburse providers if claims lacked FLR data.
The goal of FLR was to establish an evidence-based connection between rehab therapy treatment and patient progress. CMS initially hoped to use the information it collected from FLR (and its accompanying G-codes) to get a better sense of the Medicare beneficiary population, evaluate the effectiveness of the therapy treatment those patients received, and develop future payment structures for therapy services. But over time, CMS realized that the data it was collecting through FLR wasn’t suited for any of those purposes—which was part of why it discontinued the program.
FLR Completion
To comply with FLR, therapists had to 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 had Medicare proper as their primary or secondary insurance. Therapists did not need to complete FLR for patients who had Medicare replacement or Medicare Advantage (MA) plans.
Therapists could only report functional limitation data on each patient’s’ primary functional limitation—in other words, the main reason the patient sought rehabilitative services. However, therapists were permitted to treat as many limitations as was appropriate.
Medicare documentation and claims needed to include two FLR G-codes—each followed by a severity modifier and a therapy modifier—for a total of six FLR codes.
To see what functional limitation reporting was like in action, check out this post.
Medicare Claim Forms
Therapists who saw Medicare patients had to submit FLR G-codes as separate line items on Medicare claims. First, they entered the regular CPT codes (as on a normal claim) to indicate the treatment they provided. Then, they submitted each G-code with a nominal charge ($0.01). For claims that were longer than one page, therapists entered the total for item 27 on the last CMS-1500 claim form.
Reimbursements
To ensure that therapists received proper reimbursement for their services, WebPT recommended that they adhere to the following tips from now-retired compliance expert Tom Ambury:
- Create clear, detailed documentation during each patient’s episode of care.
- Audit your clinic’s documentation process regularly to ensure defensibility.
- File your claims in a timely manner.
- Stay current on reporting regulations, requirements, and legislation.
- Have a knowledgeable and trustworthy source for compliance information in case you have a question.
Rejections
If providers received rejection letters in response to their submitted claims because they omitted FLR data, there wasn’t much they could do—unless they were in a situation in which they actually did identify their 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—that was the case, providers were permitted to go back, create an addendum with the missing codes, and re-submit their claims. However, addendums were liable to throw up red flags for Medicare. To learn more about the appropriateness of creating addendums, therapists were encouraged to contact their local MAC or a compliance expert. Under no circumstances were therapists allowed to go back and change their documentation to meet FLR requirements.
Now, on to the codes. Just to reiterate: these G-codes and severity modifiers are no longer mandatory on Medicare claims.
Physical Therapy and Occupational Therapy 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 occupation 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 are still actively used; they indicate the type of therapy services that are provided to a patient.
| Modifier | Services Delivered Under Outpatient POC |
| GO | Occupational Therapy |
| GP | Physical Therapy |
| GN | Speech-Language Pathology |
What were FLR outcome measurement tools?
Outcome measurement tools are objective tests that therapists used to help determine the severity and complexity of their patients’ functional limitations. Here are some of the outcome measurement tools that were available for rehab therapists to use to satisfy FLR requirements (please note that therapists still use these tools to set, and monitor progress toward, patient goals outside of FLR reporting):
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 | |
| Falls Efficacy Scale | 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 |
What were 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 2023?
G-codes are no longer mandatory—for PQRS or for FLR—and PTs, OTs, and SLPs no longer have to include them on Medicare claims. Providers are also no longer able to use G-codes to report quality measures for MIPS.
Don’t face Medicare compliance alone.