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Corporate

Therapy Functional Reporting

Functional data reporting is required on home health outpatient claims (type of bill 34X) with therapy services provided on and after January 1, 2013, and before January 1, 2019. For assistance, the following chart illustrates when reporting is required and what G-codes would be used for the scenario in which a beneficiary has two functional limitations at the outset of the therapy episode. The therapist reports the mobility one first. The second functional limitation is not defined by any of the other 3 categorical G-code sets.

Note: Effective for dates of service on or after January 1, 2019, HCPCS G-codes and severity modifiers for functional reporting are no longer required on claims for therapy services.  Refer to Medicare Learning Network (MLN) Matters® article, MM11120External PDF, Updates to Reflect Removal of Functional Reporting Requirements and Therapy Provisions of the Bipartisan Budget Act of 2018 for additional information.  

Key: Reporting Period (RP) Begin RP #1 for Mobility at Episode Outset End RP #1 for Mobility at Progress Report Mobility RP #2 Begins Next Treatment Day End RP #2 for Mobility at Progress Report Mobility RP #3 Begins Next Treatment Day D/C of End Reporting for Mobility Begin RP #1 for Other PT/OT Primary
Mobility: Walking & Moving Around
G8978 – Current Status X X   X      
G8979 – Goal Status X X   X   X  
G8980 – Discharge Status           X  
Other PT/OT Primary
G8990 – Current Status             X
G8991 – Goal Status             X
G8992 – Discharge Status              
No Functional Reporting Required     X   X    

Tip: For every 'Current' or 'Discharge' status, you also need the 'Goal' status.

Resources:

Updated: 02.04.19

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