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How to Submit
Claims for
Therapy Services Functional
Limitation Reporting and
Severity/Complexity Modifiers
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Here are your G-Codes for Claims-Based Functional
Reporting for CY 2013 and the Severity/Complexity Modifiers:

Mobility: Walking & Moving Around
G8978        Mobility: walking & moving around functional limitation,
current status, at therapy episode outset and at reporting intervals
G8979        Mobility: walking & moving around functional limitation,
projected goal status, at therapy episode outset, at reporting intervals,
and at discharge or to end reporting
G8980        Mobility: walking & moving around functional limitation,
discharge status, at discharge from therapy or to end reporting
Determine the Appropriate severity/complexity modifier:
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

Changing & Maintaining Body Position
G8981        Changing & maintaining body position functional limitation,
current status, at therapy episode outset and at reporting intervals
G8982        Changing & maintaining body position functional limitation,
projected goal status, at therapy episode outset, at reporting intervals,
and at discharge or to end reporting




G8983        Changing & maintaining body position functional limitation,
discharge status, at discharge from therapy or to end reporting
Determine the Appropriate severity/complexity modifier:
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


Carrying, Moving & Handling Objects
G8984        Carrying, moving & handling objects functional limitation,
current status, at therapy episode outset and at reporting intervals
G8985        Carrying, moving & handling objects functional limitation,
projected goal status, at therapy episode outset, at reporting intervals,
and at discharge or to end reporting
G8986        Carrying, moving & handling objects functional limitation,
discharge status, at discharge from therapy or to end reporting
Determine the Appropriate severity/complexity modifier:
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


Self Care
G8987        Self care functional limitation, current status, at therapy
episode outset and at reporting intervals
G8988        Self care functional limitation, projected goal status, at therapy
episode outset, at reporting intervals, and at discharge or to end reporting
G8989        Self care functional limitation, discharge status, at discharge
from therapy or to end reporting




Determine the Appropriate severity/complexity modifier:
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

Other PT/OT Primary Functional Limitation
G8990        Other physical or occupational primary functional limitation,
current status, at therapy episode outset and at reporting intervals
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
G8992        Other physical or occupational primary functional limitation,
discharge status, at discharge from therapy or to end reporting
Determine the Appropriate severity/complexity modifier:
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

Other PT/ OT Subsequent Functional Limitation
G8993        Other physical or occupational subsequent functional
limitation, current status, at therapy episode outset and at reporting
intervals
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
G8995        Other physical or occupational subsequent functional
limitation, discharge status, at discharge from therapy or to end reporting
Determine the Appropriate severity/complexity modifier:
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

Your Functional Limitation Reporting should be performed as
follows:
1. Date of Initial Evaluation
2. At least every 10th Visit
3. Date of Re-evaluation
4. Discharge Date of Service
5. When further therapy treatment is necessary
6. When a new or different functional began under the same episode of
care

Take note that these G-Codes and Severity Modifiers are
non-reimburseable codes.

For Example:
Initial Evaluation for Physical Therapy Service

This is how you will code and submit/report the claim:

97001        GP                                $49.00                
97110        GP                                $38.00
97140        GP                                $32.00
G8978        GP        CM                  $00.00
G8979        GP        CI                    $00.00
G8427        GP                                $00.00
G8730        GP                                $00.00
GP8539      GP                               $00.00

** Take note that the G8427, G8730 and G8539 are for PQRS if required.
Please learn more on PQRS Reporting for Therapy providers!


Read more about this new guideline and reporting of functional limitation
to Medicare! See attached PDF file downloaded from CMS

CMS-Manual-System-Pub-100-04-Medicare-Claims-Processing-Transmittal
2622 SUMMARY OF CHANGES: This Change Request implements the
MCTRJCA claims-based data collection requirement for outpatient therapy
services by requiring the reporting of 42 new nonpayable functional
G-codes and 7 new modifiers on claims for physical therapy (PT),
occupational therapy (OT) and speech-language pathology (SLP) services.

EFFECTIVE DATE: January 01, 2013