What are Physical Therapy Medicare G-Codes and How Do You Score a Patient?

If you are new to G-codes, the best way to describe them is as quality data codes that rehab therapy providers (including physical therapists, occupational ones and speech-language pathologists) include on their Medicare claim forms to fulfill the requirements for the Functional Limitation Reporting (FLR).

Functional Limitation Reporting, on the other hand, is a CMS reporting regulation for physical therapists, occupational ones and speech-language pathologists who provide outpatient therapy services to Medicare beneficiaries. The goal here is to establish an evidence-based connection between rehab therapy treatment and patient progress.

The sets of G-codes for FLR are unique – and CMS uses the sets of them to track information about the Medicare beneficiaries’ function and condition. Below, we are listing all of the 42 available FLR G-codes organized by category and specialty, followed by a list of (70) modifiers and therapy modifiers.

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-CodeDescription                                     Short Descriptor         
           G8981            Changing and maintaining body position functional limitation, current status, at therapy episode outset, and at reporting intervals.Body position current status
G8982Changing 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
G8983Changing 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-CodeDescriptionShort Descriptor
G8984Carrying, moving, and handling objects functional limitation, current status, at therapy episode, and at reporting intervalsCarry current status
G8985Carrying, moving, and handling objects functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reportingCarry goal status
G8986Carrying, moving, and handling objects functional limitation, discharge status, at discharge from therapy or to end reportingCarry discharge status

Self Care

G-CodeDescriptionShort Descriptor
G8987Self care functional limitation, current status, at therapy episode outset, and at reporting intervals.Self care current status
G8988Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingSelf care goal status
G8989Self care functional limitation, discharge status, at discharge from therapy or to end reportingSelf care discharge status

Other PT/OT Primary Functional Limitation

G-CodeDescriptionShort Descriptor
G8990Other physical or occupational primary functional limitation, current status, at therapy episode outset, and at reporting intervalsOther PT/OT current status
G8991Other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reportingOther PT/OT goal status
G8992Other physical or occupational primary functional limitation, discharge status, at discharge from therapy to end reportingOther PT/OT discharge status

Other PT/OT Subsequent Functional Limitation

G-CodeDescriptionShort Descriptor
G8993Other physical or occupational subsequent functional limitation, current status, at therapy episode outset, and at reporting intervalsSub PT/OT current status
G8994Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingSub PT/OT goal status
G8995Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reportingSub PT/OT discharge status

Speech-Language Pathology G-Codes

Swallowing

G-CodeDescriptionShort Descriptor
G8996Swallowing functional limitation, current status, at therapy episode outset, and at reporting intervalsSwallow current status
G8997Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingSwallow goal status
G8998Swallowing functional limitation, discharge status, at discharge from therapy or to end reportingSwallow discharge status

Motor Speech

G-CodeDescriptionShort Descriptor
G8999Motor speech functional limitation, current status, at therapy episode outset, and at reporting intervalsMotor speech current status
G9186Motor speech functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingMotor speech goal status
G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reportingMotor speech discharge status

Spoken Language Comprehension

G-CodeDescriptionShort Descriptor
G9159Spoken language comprehension functional limitation, current status, at therapy episode outset, and at reporting intervalsSpoken language comprehension current status
G9160Spoken language comprehension functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingSpoken language comprehension goal status
G9161Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reportingSpoken language comprehension discharge status

Spoken Language Expression

G-CodeDescriptionShort Descriptor
G9162Spoken language expression functional limitation, current status, at therapy episode outset, and at reporting intervalsSpoken language expression current status
G9163Spoken language expression functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingSpoken language expression goal status
G9164Spoken language expression functional limitation, discharge status, at discharge from therapy or to end reportingSpoken language expression discharge status

Attention

G-CodeDescriptionShort Descriptor
G9165Attention functional limitation, current status, at therapy episode outset, and at reporting intervalsAttention current status
G9166Attention functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingAttention goal status
G9167Attention functional limitation, discharge status, at discharge from therapy or to end reportingAttention discharge status

Memory

G-CodeDescriptionShort Descriptor
G9168Memory functional limitation, current status, at therapy episode outset, and at reporting intervalsMemory current status
G9169Memory functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingMemory goal status
G9170Memory functional limitation, discharge status, at discharge from therapy or to end reportingMemory discharge status

Voice

G-CodeDescriptionShort Descriptor
G9171Voice functional limitation, current status, at therapy episode outset, and at reporting intervalsVoice current status
G9172Voice functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingVoice goal status
G9173Voice functional limitation, discharge status, at discharge from therapy or to end reportingVoice discharge status

Other Speech-Language Pathology

G-CodeDescriptionShort Descriptor
G9174Other speech-language pathology functional limitation, current status, at therapy episode outset, and at reporting intervalsOther speech-language pathology current status
G9175Other speech-language pathology functional limitation, projected goal status, at therapy episode outset, at reporting intervals, at discharge or to end reportingOther speech-language pathology goal status
G9176Other speech-language pathology functional limitation, discharge status, at discharge from therapy or to end reportingOther speech-language pathology discharge status

Functional Limitation Severity Modifier Codes

ModifierImpairment Limitation Restriction
CH0% impaired, limited, or restricted
CIAt least 1% but less than 20% impaired, limited, or restricted
CJAt least 20% but less than 40% impaired, limited, or restricted
CKAt least 40% but less than 60% impaired, limited, or restricted
CLAt least 60% but less than 80% impaired, limited, or restricted
CMAt least 80% but less than 100% impaired, limited, or restricted
CN100% impaired, limited, or restricted

Functional Limitation Therapy Modifier Codes

Therapy modifiers indicate the type of therapy service you’re providing.

ModifierServices Delivered Under Outpatient POC
GOOccupational Therapy
GPPhysical Therapy
GNSpeech-Language Pathology

 

If you are a practice that sees Medicare patients or Medicare HMOs, it is super important to know how and when using G-codes is appropriate.  If you use a EMR software, it is extremely helpful to have these codes populate from the EMR into the billing software automatically.  As the provider, it allows me to know that the functional deficits I am seeing with a patient translates directly into the billing.  With www.HENO.io it is a simple process and makes my job as the PT so much easier!

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