Use New G Codes for Medicare Therapy Claims

Starting with services dated Jan. 1, 2013, physicians have to report new, nonpayable G codes  (PDF) and related severity/complexity modifiers on Medicare claims for outpatient physical, speech, and occupational therapy.

The Centers for Medicare & Medicaid Services will collect data on the claim forms about patient functional status at the outset of therapy (initial evaluation), every 10 visits, and at discharge.

A testing period will be in effect from Jan. 1, 2013, through June 30, 2013, during which time Medicare will process claims without the G-codes and modifiers. For services on or after July 1, 2013, Medicare will reject applicable claims without the required functional G-code/modifier information.

Note that the codes apply to the therapy services furnished incident to the service of a physician and certain nonphysician practitioners, including nurse practitioners, certified nurse specialists, and physician assistants.

For more information, and a list of the G code/modifiers, see MLN Matters No. MM8005 (PDF).

Published Jan. 10, 2013 


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