Functional Limitation Reporting testing period ends June 30, 2013 (testing period: 1/1/13-6/30/13).   All claims beginning July 1 must have the functional limitation reporting G- codes and severity modifiers or your claims will be rejected and returned. If for some reason you submit claims without the G-codes and severity modifiers, Business Office Managers may resubmit their claims with the G codes and severity modifiers.   MLN8005 with Functional Limitation Reporting information can be found here http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8005.pdf

Important information from CMS!  Therapists, Therapy Managers, Business Office Managers—ALERT!

  • If you have been submitting G-Codes and severity modifiers during the testing period (prior to July 1st) on a beneficiary and that beneficiary is still receiving therapy services, then you do not need to restart functional limitation reporting on July 1st.  Wait until the next required reporting interval (10th visit or re-cert or discharge) is scheduled for that beneficiary and report the appropriate G-codes and modifiers at that time.
  • If you started treated prior to July 1st, the beneficiary is still receiving therapy services, and you DID NOT report G-codes and severity modifiers during the testing period, therapists must submit data on the first claim with the date of service on or after July 1st.

CMS has posted “functional reporting: PT, OT , and SLP services frequently asked questions (FAQs)” on the therapy services webpage.  To see that document, click here http://www.cms.gov/Medicare/Billing/TherapyServices/index.html

Gina Tomcsik

Director of Compliance

Functional Pathways

ghenthorne@fprehab.com