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Functional Limitation Reporting, G-codes and Severity / Complexity Modifiers


The functional data reporting and collection system is effective for therapy services with dates of service on and after January 1, 2013. However, a testing period will be in effect from January 1, 2013, through June 30, 2013, to allow providers to use the new coding requirements in order to assure that their systems work. During this time period claims without G-codes and modifiers will be processed.

Effective for the dates of services from July 1, 2013 Medicare will begin returning and rejecting claims, as applicable, that do not contain the required functional G-code / modifier information.

Function-related G-codes

The following Healthcare Common Procedure Coding System (HCPCS) G-codes are used to report the status of a beneficiary’s functional limitations: Please note that these codes are non-payable and are used only for reporting purposes.

Mobility G-code set:

• G8978, Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals.
Short descriptor: Mobility current status

• G8979, Mobility: walking & 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 & moving around functional limitation, discharge status, at discharge from therapy or to end reporting.
Short descriptor: Mobility D/C status

Changing & Maintaining Body Position G-code set:

• G8981, Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals.
Short descriptor: Body pos current status

• G8982, Changing & 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 & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting.
Short descriptor: Body pos D/C status

Carrying, Moving & Handling Objects G-code set:

• G8984, Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals
Short descriptor: Carry current status

• G8985, Carrying, moving & 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 & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting
Short descriptor: Carry D/C status

Self Care G-code Set:

• 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, and 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 D/C status

Other PT/OT Primary G-code Set:

• 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 or to end reporting
Short descriptor: Other PT/OT D/C status

Other PT/OT Subsequent G-code Set:

• G8993, Other physical or occupational 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, and 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 D/C status

Swallowing G-code Set:

• G8996, Swallowing functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Swallow current status

• G8997, Swallowing functional limitation, projected goal status, at initial therapy treatment/outset and at discharge from therapy
Short descriptor: Swallow goal status

• G8998, Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation
Short descriptor: Swallow D/C status

Motor Speech G-code Set: (Note: These codes are not sequentially numbered)

• G8999, Motor speech functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor Motor speech current status

• G9186, Motor speech functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor Motor speech goal status

• G9158, Motor speech functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Motor speech D/C status

Spoken Language Comprehension G-code Set:

• G9159, Spoken language comprehension functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Lang comp current status

• G9160, Spoken language comprehension functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor: Lang comp goal status

• G9161, Spoken language comprehension functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Lang comp D/C status

Spoken Language Expressive G-code Set:

• G9162, Spoken language expression functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Lang express current status

• G9163, Spoken language expression functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor: Lang express goal status

• G9164, Spoken language expression functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Lang express D/C status

Attention G-code Set:

• G9165, Attention functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Atten current status

• G9166, Attention functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor Atten goal status

• G9167, Attention functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Atten D/C status

Memory G-code Set:

• G9168, Memory functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Memory current status

• G9169, Memory functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor: Memory goal status

• G9170, Memory functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Memory D/C status

Voice G-code Set:

• G9171, Voice functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor Voice current status

• G9172, Voice functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor Voice goal status

• G9173, Voice functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: Voice D/C status

Other Speech Language Pathology G-code Set:

• G9174, Other speech language pathology functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
Short descriptor: Speech lang current status

• G9175, Other speech language pathology functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
Short descriptor: speech lang goal status

• G9176, Other speech language pathology functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Short descriptor: speech lang D/C status

Severity/Complexity Modifiers

For each non-payable G-code shown above, a modifier must be used to report the severity/complexity for that functional measure. The severity modifiers reflect the beneficiary’s percentage of functional impairment as determined by the therapist, physician, or NPP furnishing the therapy services. The beneficiary’s current status,
the anticipated goal status, and the discharge status are reported via the appropriate severity modifiers. The seven modifiers are defined in the following table:

CH - 0 percent impaired, limited or restricted

CI - At least 1 percent but less than 20 percent impaired, limited or restricted

CJ - At least 20 percent but less than 40 percent impaired, limited or restricted

CK - At least 40 percent but less than 60 percent impaired, limited or restricted

CL - At least 60 percent but less than 80 percent impaired, limited or restricted

CM - At least 80 percent but less than 100 percent impaired, limited or restricted

CN - 100 percent impaired, limited or restricted

Required Reporting of Functional G-codes and Severity Modifiers

The functional G-codes and corresponding severity modifiers listed above are used in the required reporting on specified therapy claims for certain Dates of Service (DOS). Only one functional limitation shall be reported at a given time for each related therapy plan of care (POC). However, functional reporting is required on claims throughout the entire episode of care; so, there will be instances where two or more functional limitations will be reported for one beneficiary’s POC, just not during the same time frame. In these situations, where reporting on the first reported functional limitation is complete and the need for treatment continues, reporting is required for a second functional limitation using another set of G-codes. Thus, reporting on more than one functional limitation may be required for some beneficiaries, but not simultaneously.

Specifically, functional reporting, using the G-codes and modifiers, is required on therapy claims for certain DOS as described below:

• At the outset of a therapy episode of care, i.e., on the DOS for the initial therapy service;

• At least once every 10 treatment days -- which is the same as the newly-revised progress reporting period -- the functional reporting is required on the claim for services on same DOS that the services related to the progress report are furnished;

• The same DOS that an evaluative procedure, including a re-evaluative one, is submitted on the claim (see below for applicable HCPCS/CPT codes);

• At the time of discharge from the therapy episode of care, if data is available; and,

• On the same DOS the reporting of a particular functional limitation is ended, in cases where the need for further therapy is necessary.

For more information please visit: http://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/MM8005.pdf


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