Home Health & Hospice

Therapy G-Codes Decoded

Homecare Insider, January 31, 2011

Effective January 1, 2011, the Centers for Medicare and Medicaid Services (CMS) implemented new and revised G-codes for therapy services. This was done to collect additional data on home health claims to differentiate between the therapy visits provided by therapy assistants and those provided by qualified therapists and to also differentiate the types of therapy services provided.

The G-code descriptions for qualified therapists have been revised to include that they must be utilized to report services provided by qualified therapist for physical, occupational, or speech therapy. Two new G-codes were added to report restorative therapy provided by qualified physical or occupational therapy assistants. In addition, CMS added three new G-codes and is requiring that they be utilized for reporting the establishment or delivery of therapy maintenance programs by qualified physical, occupational, and speech therapists.

CMS defines maintenance therapy as repetitive therapy services that are required to maintain function and involve the use of complex and sophisticated procedures and the judgment and skill of a qualified therapist. If the judgment and skill of a qualified therapist is required to safely and effectively treat the illness or injury, these services are covered.

Providers can find additional information about G-code reporting requirements in Change Request 7182 located at http://www.cms.gov/transmittals/downloads/R824OTN.pdf. Providers can find coverage requirements including service delivery and documentation guidelines in the Medicare Benefit Policy Manual, CMS Publication 100-2, Chapter 7.

More questions about G-codes? Beacon Health’s February audio conference will discuss G-codes, including descriptions of each code, an explanation on how G-codes are directly related the skilled service provided, and examples of compliance. For more information, visit the Beacon Health Online Store.