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 (FCM) levels are listed here. Use of NOMS can assist with G-code and severity modifier selection, but is not required by CMS. Visit the NOMS website for more information on individual and facility participation in NOMS.

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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