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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