Update on G-Code Requirements

By RehabCare

The Middle Class Tax Relief and Jobs Creation Act of 2012 contained several provisions specifically focusing on outpatient rehabilitative therapies, including the Medical Manual Review trigger at $3,700 and the establishment of new “G Codes.”

The law specifically directed the U.S. Department of Health and Human Services (HHS) to implement a “claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services”and to begin testing such a model in early 2013. The goal of the data collection is to “better understand patient condition and outcomes.” This led to the development of 42 new non-payable functional of G-codes for physical and occupational therapy and speech pathology services also referred to as functional limitation reporting.

Beginning on July 1, 2013, providers will be required to include G-codes and severity/complexity modifiers to indicate the patient’s functional status at:

  • The outset of the therapy episode of care,
  • Specified points during treatment (progress reports to be furnished on or before every 10th treatment day), and
  • Time of discharge.

Applicable claims without the G-codes will be rejected.

In conjunction with using the appropriate G-code, claims require one of seven modifiers that identify the range of a patient’s functional impairment. For example, modifier “CM” would be applied to identify that the patient is “at least 80 percent but less than 100 percent impaired, limited or restricted.”

This coding change aligns with RehabCare’s long-term practice of tracking and reporting the functional outcomes of our patients.

We worked closely with our technology partners to ensure that our hand-held systems were fully tested and prepared for the July 1 implementation date, and we are confident in RehabCare’s ability to appropriately meet the new requirements for therapy patients across the care continuum.

By RehabCare