Physical Therapists’ Guide to G-Codes
As a physical therapist, you are likely familiar with the use of G-codes. Until January 1, 2017, these codes were used as quality data codes that must be indicated on Medicare claim forms to fulfill FLR (Functional Limitation Reporting) requirements. Rehab therapy providers — including eligible speech-language pathologists, occupational therapists, and physical therapists — were required to use them. The Centers for Medicare and Medicaid Services (CMS) originally intended this set of G code for physical therapy to be used for tracking information on a beneficiary’s condition and function, as well as for reporting for PQRS, a now-defunct quality reporting program.
But starting January 1, 2019, it is no longer necessary for providers to report severity modifiers or G-Codes for Medicare FLR. All Medicare FLR requirements were eliminated by CMS in the 2019 physician fee schedule because the program was a burden on participants.
Still, G-codes were used for another year, as CMS wanted providers to have more time to phase them out and to prevent billing problems. As a result, Medicare FLR became optional in 2019.
If you are using physical therapy software, it is important to verify that it is using the latest codes to avoid non-compliance issues with claims. It should have an upgraded reporting system with built-in alerts to ensure a compliant practice.
The problem with G-codes
Before going further, it is important to know what FLR is about. Functional Limitation Reporting was the CMS (Centers for Medicare and Medicate Services) reporting regulation for speech-language pathologists, physical therapists, and occupational therapists who delivered outpatient therapy services to Medicare beneficiaries. Medicare did not reimburse them if they lacked FLR data.
The objective of FLR was to set an evidence-based connection between patient progress and rehab therapy treatment. CMS intended to use the information it collected from every G code for physical therapy and FLR to better understand the beneficiary population of Medicare, create future payment structures, and determine the efficacy of the patients’ respective therapy treatments. However, it eventually realized that the data was not ideal for those purposes, so the program was discontinued.
Completing FLR
For FLR compliance, practitioners had to report functional limitation data via G-codes at the first examination, at least every 10th visit, and at discharge, as long as the patient had Medicare proper as their secondary or primary insurance. They also had to state the corresponding modifiers for therapy and severity. However, therapists did not have to complete FLR for those who had MA (Medicare Advantage) or Medicare replacement plans.
Therapists were only permitted to report functional limitation data on every patient’s primary functional limitation or the main reason the patient sought treatment. However, therapists were allowed to treat as many limitations as they deemed appropriate.
Medicare claims and documentations had to include two FLR G-codes where each must be followed by a therapy modifier and a severity modifier, resulting in a total of six FLR codes.
Medicare claim forms
Therapists of Medicare patients had to submit FLR G-codes as separate line items on claims. They inputted the regular CPT codes to indicate the treatment, then submitted every G code for physical therapy with a $0.01 nominal charge. For claims with more than one page, therapists had to enter the total for item 27 on the last claim form of CMS-1500.
What are the G-codes?
These severity modifiers and G-codes are no longer necessary on Medicare claims.
Choosing G-codes for your patients is simple with Apollo’s fully-integrated Functional Limitation Reporting feature.
