Get a Better Grasp on Medicare G Codes and Modifiers

Get a Better Grasp on Medicare G Codes and Modifiers

Append seven modifiers appropriately to G codes for correct reporting of therapy services.

In 2013, the Centers for Medicare & Medicaid Services (CMS) developed a system of functional reporting for therapy services. This system is used to report conditions and outcomes for patients receiving physical therapy (PT), occupational therapy (OT), and/or speech-language therapy (SLT).

Indicate Patient Status

Functional reporting codes are called G codes, and indicate the condition of the patient. There are four sets of G codes used primarily for PTs and OTs. Within each set, there are three G codes to indicate the patient’s status, goal status, and discharge status. They include:

Mobility G Code Set

G8978 Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals – Mobility current status

G8979 Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting – Mobility goal status

G8980 Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting – Mobility discharge (D/C) status

Changing and Maintaining Body Positions G Code Set

G8981 Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals – Body position current status

G8982 Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting – Body position goal status

G8983 Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting – Body position D/C status

Carrying, Moving, and Handling Objects G Code Set

G8984 Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals – Carry current status

G8985 Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting – Carry goal status

G8986 Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting – Carry D/C status

Self Care G Code Set

G8987 Self care functional limitation, current status, at therapy episode outset and at reporting intervals – Self-care current status

G8988 Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting – Self-care goal status

G8989 Self care functional limitation, discharge status, at discharge from therapy or to end reporting – Self-care D/C status

There are two additional code sets for the PT/OTs, which are used less frequently. They are:

Other PT/OT Primary G Code Set

G8990 Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals – Other PT/OT current status

G8991 Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting – Other PT/OT goal status

G8992 Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting – Other PT/OT D/C status

Other PT/OT Subsequent G Code Set

G8993 Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals – Sub PT/OT current status

G8994 Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting – Sub PT/OT goal status

G8995 Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting – Sub PT/OT D/C status

There are eight additional code sets primarily used for SLPs.

Severity Modifiers and Impairment Limitation Restrictions

Modifiers are used to indicate the patient’s level of impairment. There are seven modifiers, one for each percentage level of impairment, ranging from 0 to 100 percent. These modifiers are required for all therapists, regardless of the type of therapy performed.

CH           0 percent impaired, limited or restricted

CI             At least 1 percent but less than 20 percent impaired, limited or restricted

CJ             At least 20 percent but less than 40 percent impaired, limited or restricted

CK            At least 40 percent but less than 60 percent impaired, limited or restricted

CL            At least 60 percent but less than 80 percent impaired, limited or restricted

CM          At least 80 percent but less than 100 percent impaired, limited or restricted

CN           100 percent impaired, limited or restricted

Code from Start to Finish

The therapist assigns the appropriate set of G codes and modifiers at the time of the patient’s initial evaluation. These codes can only be reported by the therapist — not a therapist assistant. The therapist determines the set of G codes and modifiers based on questions, the patient’s answers on health history forms (as they relate to the patient’s condition), and the initial evaluation performed. The patient’s goal of what they want to achieve with therapy also is determined at this time. The codes indicating the patient’s status and goal status are billed to Medicare on the same date of service (DOS) as the initial evaluation. If these codes are not included on the claim, the claim will be denied, as well as subsequent claims.

Only one set of functional reporting G codes may be used per therapy session, based on the assessment. If the code set needs to be changed, the patient must be “discharged” from the original code set. The patient must then be re-evaluated and the new code set reported at the next visit.

The patient’s status must be updated and reported to Medicare every eight to 10 visits, via claims submission. These updates continue for the duration of the therapy session. The patient’s status also needs to be updated and reported every time the patient is re-evaluated. By reporting the patient’s status, the therapist is indicating whether the services are helping the patient achieve their goals, as set forth in the initial visit and evaluation. The G code reporting substantiates the services performed. The codes must be submitted on the claim for the same DOS as the 10th visit or the re-evaluation; otherwise, the claim will be denied, as well as subsequent claims.

After the patient has attained their goal, as set forth in the initial visit, or it is determined the goal is unattainable, they are discharged from the therapy session. On the last visit of the session, the therapist evaluates the patient to ascertain whether discharge is warranted. The patient’s goal status and discharge status must be reported on the same claim DOS as the last visit. The patient is then done with this particular therapy session.


Christina Hunt, CPC, AAPC Fellow, has worked in the insurance and medical fields for over 20 years. She received her certification in 2013, and works for the University of Kansas St. Francis Campus as a coder for various specialty clinics. Hunt served as the treasurer for two years and is the 2018 president for the NEKAAPC local chapter in Topeka, Kans.

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