American Speech-Language-Hearing Association

G-Codes and Severity Modifiers for Claims-Based Outcomes Reporting

Medicare Part B Therapy Services

The Centers for Medicare & Medicaid Services (CMS) established non-payable G-codes for reporting on claims for Medicare Part B beneficiaries receiving therapy services. Each non-payable G-code listed on the claim form must be accompanied with a severity/complexity modifier. The modifier represents the functional impairment on a 7-point severity/complexity scale. The G-codes related to speech-language pathology services and severity modifiers are listed in the tables below.

Speech-Language Pathology Related G-Codes

G-Codes Functional Limitation & Status
Swallowing
G8996 Swallowing functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G8997 Swallowing functional limitation, projected goal status, at initial therapy treatment/outset and at discharge from therapy
G8998 Swallowing functional limitation, discharge status, at discharge from therapy/end of reporting on limitation
Motor Speech (Note: The codes for Motor Speech are not sequentially numbered)
G8999 Motor speech functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9186 Motor speech functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9158 Motor speech functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Spoken Language Comprehension
G9159 Spoken language comprehension functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9160 Spoken language comprehension functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9161 Spoken language comprehension functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Spoken Language Expression
G9162 Spoken language expression functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9163 Spoken language expression functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9164 Spoken language expression functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Attention
G9165 Attention functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9166 Attention functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9167 Attention functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Memory
G9168 Memory functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9169 Memory functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9170 Memory functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Voice
G9171 Voice functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9172 Voice functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9173 Voice functional limitation, discharge status at discharge from therapy/end of reporting on limitation
Other SLP Functional Limitation
G9174 Other speech language pathology functional limitation, current status at time of initial therapy treatment/episode outset and reporting intervals
G9175 Other speech language pathology functional limitation, projected goal status at initial therapy treatment/outset and at discharge from therapy
G9176 Other speech language pathology functional limitation, discharge status at discharge from therapy/end of reporting on limitation

Severity Modifiers

Note: Corresponding National Outcomes Measurement System (NOMS) Functional Communication Measures [PDF] levels are listed here. Use of NOMS can assist with G-code and severity modifier selection, but is not required by CMS.

Modifier Impairment Limitation Restriction FCM Level
CH 0 percent impaired, limited or restricted 7
CI At least 1 percent but less than 20 percent impaired, limited or restricted 6
CJ At least 20 percent but less than 40 percent impaired, limited or restricted 5
CK At least 40 percent but less than 60 percent impaired, limited or restricted 4
CL At least 60 percent but less than 80 percent impaired, limited or restricted 3
CM At least 80 percent but less than 100 percent impaired, limited or restricted 2
CN 100 percent impaired, limited or restricted 1

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