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

For traditional Medicare, Claims-Based Outcomes Reporting (Functional Limitation Reporting) has ended for any services rendered on or after January 1, 2019. Any Medicare advantage or private plans who chose to adopt Functional Limitation Reporting may elect to continue the program so it is best to check directly with those payers.

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