According to the Centers for Medicare & Medicaid Services (CMS), G-codes are “used to report a beneficiary’s functional limitation being treated and note whether the report is on the beneficiary’s current status, projected goal status, or discharge status.” CMS uses these codes to track information about Medicare beneficiaries’ “function and condition.”
As of January 2017, physical therapists no longer have to report G-codes for Physician Quality Reporting System (PQRS), so this post will only focus on Functional Limitation Reporting (FLR).
FLR is used to establish the effectiveness of the treatment the Medicare beneficiary population is receiving. It does this by showing evidence of the connection between rehab therapy and patient progress.
According to WebPT, therapists must report functional limitation data in the form of G-codes, along with the severity modifier and therapy modifier at the initial evaluation, every tenth visit and at discharge for all patients who have Medicare as their primary or secondary insurance. FLR is not needed for patients who have Medicare replacement or Advantage plans.
You should only report functional limitation data on “each patient’s functional limitation… However, you should continue treating as many limitations as appropriate.”
To guarantee you receive appropriate reimbursement for these services: **Tips from WebPT and 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
To learn more about how to use G-codes and to see a full list of G-codes and modifiers for FLR, check out this Quick Reference Chart from CMS.
