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Printed Date: 9/22/2015
At least 60 percent but less than 80 percent impaired, limited or restricted.
Guidelines and Instructions
Required Reporting of Functional G-codes and Severity Modifiers
The functional G-codes and corresponding severity modifiers listed above are used in the required reporting on specified therapy claims for certain dates of service (DOS). Only one functional limitation shall be reported at a given time for each related therapy plan of care (POC). However, functional reporting is required on claims throughout the entire episode of care; so, there will be instances where two or more functional limitations will be reported for one beneficiary’s POC, just not during the same time frame. In these situations, where reporting on the first reported functional limitation is complete and the need for treatment continues, reporting is required for a second functional limitation using another set of G-codes. Thus, reporting on more than one functional limitation may be required for some beneficiaries, but not simultaneously.
Functional reporting, using the G-codes and modifiers, is required on therapy claims for certain DOS:
Reference: MLN Matters 8005 (PDF, 345 KB).
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Last Updated: 07/16/2020