Page 207 - Medicare Benefit Policy Manual

• Communication/consultation with other providers (e.g., supervising clinician,
attending physician, nurse, another therapist, etc.);

• Significant, unusual or unexpected changes in clinical status;

• Equipment provided; and/or

• Any additional relevant information the qualified professional finds
appropriate.

See Pub. 100-04, Medicare Claims Processing Manual, chapter 5, section 20.2 for
instructions on how to count minutes. It is important that the total number of timed
treatment minutes support the billing of units on the claim, and that the total treatment
time reflects services billed as untimed codes.

220.4 – Functional Reporting
(Rev. 255, Issued: 01-25-19, Effective: 01- 01- 19, Implementation: 02-26-19)

NOTE: In the calendar year (CY) 2019 Physician Fee Schedule (PFS) final rule, CMS-1693-
F, after consideration of stakeholder comments for burden reduction, a review of all of the
requirements under section 3005(g) of Middle Class Tax Relief and Jobs Creation Act of
2012 (MCTRJCA), and in light of the statutory amendments to section 1833(g) of the Act,
via section 50202 of Bipartisan Budget Act of 2018 to repeal the therapy caps, CMS
concluded that continued collection of functional reporting data through the same or reduced
format would not yield additional information to inform future analyses or to serve as a basis
for reforms to the payment system for therapy services. To reduce the burden of reporting
for providers of therapy services, the CY 2019 PFS final rule ended the requirements of
reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on
claims for therapy services and the associated documentation requirements in medical
records, effective for dates of service on and after January 1, 2019. The rule also revised
regulation text at 42 CFR 410.59, 410.60, 410.61, 410.62, 410.105, accordingly.

The instructions below apply only to dates of service when the functional reporting
requirements were effective, January 1, 2013 through December 31, 2018.

A. Selecting the G-codes to Use in Functional Reporting.

There are 42 functional G-codes, 14 sets of three codes each, for that can be used in
identifying the functional limitation being reported. Six of the G-code sets are generally
for PT and OT functional limitations and eight sets of G-codes are for SLP functional
limitations. (For a list of these codes and descriptors, see Pub. 100-04, Medicare Claims
Processing Manual, chapter 5, section 10.6 F.)

Only one functional limitation shall be reported at a time. Consequently, the clinician
must select the G-code set for the functional limitation that most closely relates to the
primary functional limitation being treated or the one that is the primary reason for