Outpatient Therapy Functional Reporting: Ensure You are in Compliance

CMS has implemented a new claims-based data collection system for outpatient therapy services by requiring reporting of functional limitations with 42 new nonpayable G-codes and 7 new modifiers on specified claims for physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) services. The claims-based data collection system is effective for outpatient therapy services with dates of service on and after January 1, 2013. In regard to functional reporting, CMS has been in a testing period. The testing period will come to an end on June 30.

During the testing period, claims without the required G-codes and severity/complexity modifiers will continue to be processed and adjudicated by your carrier or Part B Medicare Administrative Contractor.  Beginning April 1, a new Remittance Advice message has been alerting providers about missing information on select therapy claims. Please note: institutional claims will not receive alert messages.

Therapy claims with dates of service on or after July 1, 2013 that do not contain the required functional G-codes and corresponding modifiers will be returned or rejected, as applicable.

Learn more about the new claims-base data collection requirement for outpatient therapy here.