When to Report G-Codes

Please note that this article contains information that is only relevant to American clinics.

 

If your patients are receiving outpatient therapy services under their Medicare Part B benefits, then you’re required to complete Functional Limitations Reporting (FLR). FLR is characterized by the use of G-Codes. And there are certain circumstances in which they need to be reported. In this article, we’ll be discussing when to report G-codes.

 

There are certain times during a patient’s episode of care when their G-Codes must be reported. It may not necessarily be every time they receive treatment—but sometimes it simply must be done. Rest assured that you don’t need to report them every time a patient sees you.

 

Gawenda Seminars and Consulting recently published a very helpful article on the subject. In it, they offered some great advice about when to report G-Codes. The following are some scenarios where you’d be required to report them:

 

  • When the patient is beginning their episode of care
  • At least once every 10 treatment days (which coincides with the ‘Progress Report’ period)
  • During an evaluation or re-evaluation
  • When discharging them
  • When stop tracking a particular functional limitation yet further therapy is still required
  • If you start tracking a new functional limitation despite it being the same episode of care

 

But there are still some stipulations regarding the use of G-Codes. For instance, the Gawenda Seminars and Consulting article stated that “if a provider sees a Medicare beneficiary for an orthotic assessment and only bills the L code for the orthosis, no FLR is required… since the L code is not considered an ‘always therapy’ code.”

 

Are you confused by ‘always therapy’ codes? Click here to check out the CMS guide to Medicare Claims Processing.

 

We hope that you found this article helpful. For more great content like this, check out the Gawenda Seminars and Consulting website and learn more about the benefits of becoming a Gold Member.