31814

FISS Narrative
Per CR 8005*, these non-payable G-codes and severity/complexity modifiers provide information about the beneficiary's functional status at the outset of the therapy episode of care, at specified points during treatment, and at the time of discharge. These G-codes and related modifiers are required on selected claims for all outpatient therapy services. These are not payable by Medicare.

Explanation and Suggestion
This is a valid processing reason code. It does not reflect incorrect billing.

Implementation of Claims-Based Data Collection Requirement for Outpatient Therapy Services — Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act of 2012 requires claims to be reported with 42 new non-payable functional G-codes and seven new modifiers on claims for Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services.

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