Is functional limitation reporting ending at the end of 2018? The answer depends on what insurance carrier you are asking about. For traditional Medicare Part B beneficiaries, functional limitation reporting (FLR)

On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the 2019 final rule for services paid under the Medicare Physician Fee Schedule (outpatient PT, OT and SLP services) as well as the Merit-Based Incentive Payment System (MIPS) for physical therapists, occupational therapists and speech-language pathologists in private practice. Highlights of the Final Rule include: 2019 Conversion Factor 2019 Therapy Threshold Dollar Amount 2019 Targeted Medical Review Dollar Amount Functional Limitation Reporting for 2019 New Modifiers to Distinguish Services Provided by a PTA or OTA “In Whole or In Part” Defined of a PTA or OTA Service

With the beginning of a New Year, I often receive the following questions regarding patients that were being seen for outpatient therapy in December and continue to receive therapy in January of the new year: Do I need to perform and bill for an evaluation or reevaluation on the patient’s first visit in January? Do I need an updated signed plan of care if the patient has traditional Medicare? Do I need an updated physician order for my non-Medicare patients? Must I report the functional limitation reporting G-codes on the patient’s first date of service in January? If I was

Functional Limitation Reporting (FLR) (i.e. G-codes) has been required for dates of service on and after July 1, 2013 for Medicare beneficiaries receiving outpatient therapy services being billed under their Part B Medicare benefits. I still receive many questions when G-codes have to be reported on the claim form. Many of the questions I receive concern if a therapist only bills an L code for an orthosis during the patients initial visit, do I need to report G-codes? Another question I receive is are G-codes required if on the first visit, I only bill CPT code 97542 for a wheelchair