Forum - Questions & Answers

May 20th, 2014 - dburd 1 

G Codes

Where can I find clarification for the G codes needed to bill Medicare for with NPL with Sensory and evals? Does anyone know what G codes would be billed with the 92614 ?

May 20th, 2014 - shanbull 51 

re: G Codes

This is for a speech language pathologist, yes? The G-codes being referred to are the functional limitation reporting codes, here is more information on them and what they mean: http://www.asha.org/Practice/reimbursement/medicare/G-Codes-and-Severity-Modifiers-for-Outcomes-Reporting/

To quickly summarize: the G-codes are required on the claims for the initial evaluation, every 10th visit, and the last visit (to discharge the patient). Every claim has 2 G-codes, one to state what the CURRENT limitation is, and one to state what the PROJECTED limitation will be at the end of treatment. The discharge claim will also have two G-codes, one to state the PROJECTED limitation you've always reported, and one to state the DISCHARGE status of the limitation. Each set of 3 G-codes (one for projected status, one for current status, one for discharge status) describes one type of limitation and you should not switch between the sets unless you have an extenuating circumstance. The speech language pathologist needs to be the one deciding on which functional limitation to report on and what the severity level of the limitation is.

All G-codes also require TWO MODIFIERS; the first modifier indicates the severity of the functional limitation (the list of modifiers is in the link I provided), the second will be the GN modifier to indicate the services are being offered within a speech language pathology plan of care.

Finally, and very important - the PECOS-enrolled referring physician with the individual NPI must be reported on every claim. This edit was activated by Medicare in January.

Let me know if you need more clarification, this stuff seems like a lot to remember at first but once you get used to it, it's easy enough to know what to do. It's mostly a matter of doing it several times and you get the hang of it after that.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association