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  • Functional Limitation Reporting Under Medicare: Get Answers to Your Questions

    As of yesterday, all providers billing outpatient therapy services under Medicare Part B must begin or continue submitting functional limitation data (G-codes) for any Medicare beneficiary, or claims will be returned unpaid. Therapists must report functional limitation data on the beneficiaries' current functional status and the projected goal to Medicare at scheduled intervals throughout the episode of care, including at the outset of the therapy episode, no less frequently than every 10th visit, and at discharge.

    APTA will host a Q&A call for members on Tuesday, July 9, 2:00 pm-3:00 pm ET, to answer questions about the reporting requirements. Space is limited. To register for a spot please e-mail advocacy@apta.org with "July 9 Call" in the subject line. Based on demand, we will host future calls throughout the month of July.

    For more information and resources on functional limitation reporting, please visit APTA's Functional Limitation Resource Page.


    • I see that the Q and A from CGS states to report G codes for unplanned discharges but you say do not do it. What is the correct information? Thank you.

      Posted by Robin Boyle on 7/3/2013 8:20 AM

    • I am sure that, for one reason or another, many may not be available to attend the July 9 call. Will that Q&A be recorded and archived? If so, will it be posted on the Functional Limitation Resource Page?

      Posted by Jeff on 7/8/2013 8:31 AM

    • If a patient does not finish their PT visits(doesn't get to 10) or decides to self discharge without the final G codes reported, what do you do?

      Posted by Catherine Hughes -> @GT`E on 7/8/2013 6:44 PM

    • I would also like to know what to do with patients who are an unexpected DC. Particularly if you used a functional assessment tool to measure their original statuse. Do you estimate their functional status at the time of the last visit with the patient?

      Posted by Mike on 7/9/2013 10:27 AM

    • @Jeff: APTA is planning additional calls in upcoming weeks. (Look for another story in News Now as the call information becomes available.)

      Posted by News Now Staff on 7/9/2013 3:28 PM

    • @Catherine and Mike: If a patient does not return for their discharge appointment or discontinues therapy prior to formal discharge (regardless of the reason), the therapist is not required to report the functional limitation G-codes. Discharge reporting is required only in cases where the beneficiary has a planned discharge visit. You can find answers to many questions about functional limitation reporting on our FAQs: http://www.apta.org/FLR

      Posted by News Now Staff on 7/9/2013 3:29 PM

    • Our OT saw a medicare patient one time while I was away. Do we need to use G codes for this billing? Keith Glasser

      Posted by Keith Glasser -> =HX_EL on 7/25/2013 1:23 PM

    • I am part a provider servicing part b I just find out I am not suppose to report PQRS .anybody in my place do we report g codes and got paid .please exchange information thanks

      Posted by Yalcin on 8/23/2013 8:23 PM

    • If a Medicare patient is a self discharge and they return for therapy at a future date how do you report the G-codes to discharge the prior diagnosis?

      Posted by Julie Snowden on 3/18/2014 9:24 AM

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