How To Use HCPCS Code G8991

HCPCS code G8991 describes a specific type of physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. This code is used to identify and track the progress and outcomes of therapy sessions for patients with various physical or occupational therapy needs.

1. What is HCPCS G8991?

HCPCS code G8991 is a unique alphanumeric code that is part of the Healthcare Common Procedure Coding System (HCPCS). It is used to identify and document the projected goal status of a patient’s physical or occupational therapy at the beginning of a therapy episode, at reporting intervals, and at discharge or to end reporting. This code provides valuable information about the functional limitations and goals of the therapy sessions.

2. Official Description

The official description of HCPCS code G8991 is “Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting.” The short description for this code is “Other pt/ot goal status.”

3. Procedure

1. At the therapy episode outset, the healthcare provider assesses the patient’s primary functional limitation and establishes the projected goal status.
2. Throughout the therapy sessions, the provider periodically evaluates and documents the progress of the patient’s therapy goals.
3. At the time of discharge or to end reporting, the provider assesses the final goal status and documents it accordingly.

4. When to use HCPCS code G8991

HCPCS code G8991 should be used when documenting the projected goal status of a patient’s physical or occupational therapy at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. It is important to use this code accurately to ensure proper tracking and reporting of therapy outcomes.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G8991, healthcare providers need to ensure that they have documented the patient’s primary functional limitation, the projected goal status at the therapy episode outset, at reporting intervals, and at discharge or to end reporting. This documentation should be clear, concise, and support the medical necessity of the therapy services provided.

6. Historical Information and Code Maintenance

HCPCS code G8991 was added to the Healthcare Common Procedure Coding System on January 01, 2013. It has an effective date of January 01, 2020. This code has a coverage code of C, which indicates that the carrier makes the judgment on whether to cover the service. The action code for this code is N, which means no maintenance for this code. The pricing indicator code is 00, indicating that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

7. Medicare and Insurance Coverage

HCPCS code G8991 may be payable by Medicare and other insurance providers. However, the coverage and reimbursement for this code may vary depending on the carrier’s judgment. It is important for healthcare providers to check with the specific insurance plans for their coverage policies and reimbursement rates.

8. Examples

Here are five examples of when HCPCS code G8991 should be billed:

1. A patient with a primary functional limitation in mobility undergoes physical therapy to improve their ability to walk independently. The projected goal status is to achieve a walking distance of 500 meters without assistance.
2. A patient with a primary functional limitation in fine motor skills receives occupational therapy to enhance their ability to write legibly. The projected goal status is to write a full page of text without any illegible characters.
3. A patient with a primary functional limitation in balance undergoes physical therapy to improve their stability and reduce the risk of falls. The projected goal status is to maintain balance while standing on one leg for at least 30 seconds.
4. A patient with a primary functional limitation in speech receives speech therapy to improve their communication skills. The projected goal status is to speak clearly and fluently without any significant speech impairments.
5. A patient with a primary functional limitation in self-care abilities undergoes occupational therapy to regain independence in activities of daily living. The projected goal status is to dress, bathe, and feed themselves without any assistance.