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  • More CMS Guidance on July 1 Functional Limitation Reporting Requirements

    A new FAQ page within the Centers for Medicare and Medicaid Services (CMS) web resources on functional limitation reporting confirms an e-mail communication from earlier this week about changes to requirements for submitting claims for current patients. It also clarifies other details related to the requirements.

    As a reminder, for patient visits on or after July 1, physical therapists must include the appropriate G-codes and modifiers to report functional limitation data in claims submitted for outpatient Medicare Part B beneficiaries, or claims will be returned unpaid. To reiterate the change for current patients, as APTA reported on Tuesday:

    • Therapy providers who have submitted functional limitation data (G-codes) on patients prior to July 1 will not need to restart functional limitation reporting on the first date of service on or after July 1. Instead, for these patients only, therapists can wait to submit functional limitation data until the next required reporting interval (eg, at the patient's 10th visit or at discharge).
    • For beneficiaries whose treatment began prior to July 1, but for whom functional limitation reporting information has not been submitted prior to July 1, therapists must submit data on the first claim with a date of service on or after July 1.
    • Functional limitation data will be required for all new patients as of July 1.

    The document also includes additional details on code reporting for patients under 2 plans of care and coding for observation patients in the acute care setting.

    For more information and resources on functional limitation reporting, please see APTA's Functional Limitation Reporting webpage, which includes a toolkit, links to PTNow's resources on appropriate tests and measures, and APTA's Functional Limitation Discussion Forum.


    • This is all well and good, but I have been filing the functional limitation codes and I have yet to receive any feedback about successful coding. How will we know if our claims are correct other than not getting paid for services rendered?

      Posted by Ray Tresemer, PT on 6/22/2013 6:46 PM

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