Below is great news! For any Money Tree PT & OT providers you no longer need to report the G codes in the billing database. Starting January 1st, please stop adding the G codes as charges in your system.
The ONLY time you NEED to still add these codes is if you are doing MIPS reporting. Below is the guidelines for MIPS but most of our Money Tree Providers are NOT required to report for MIPS due to the low volume threshold indicated below. IF you think you may still fall under MIPS and need to report for MIPS, please contact us to discuss this in further detail.
Beginning in January 2019, functional reporting will no longer be required for reimbursement by Medicare. PTs, OTs, and SLPs will not be required to report HCPCS codes G8978-G8999 or G9158-G9186. Also, severity modifiers CH through CN will not be required. The codes are still going to be valid for a little while to allow providers and insurers time to update their billing systems and policies (and thus, avoid claim rejections due to inadvertent non-payable code submission).
If you want, you can continue to report the codes, they just aren’t required for payment. It should be noted that even though they aren’t required for payment, they may be used by MIPS-eligible PTs, OTs, and SLPs for MIPS quality reporting in 2019.
Low Volume Threshold & MIPS Participation
Low volume thresholds for MIPS participation were also revised. Beginning in 2019, if one of the following statements holds true for a MIPS-eligible clinician or group, they will not be required to participate in MIPS:
The provider or group did not charge more than $90,000 for covered professional services.
The provider or group treated 200 or fewer Part B-enrolled individuals.
The provider or group provided 200 or fewer professional services to Part B-enrolled individuals.
Even if you are not required to participate, you can choose to either opt-in to MIPS or voluntarily report. Clinicians and groups have the opportunity to opt in to MIPS if they only meet one or two of the three low-volume thresholds listed above. If you meet all three, then you may NOT opt in but you could still participate voluntarily and obtain feedback about your reporting. Those who voluntarily report quality data will experience no MIPS payment adjustments. Those who decide to opt in for 2019 will experience payment adjustments (positive, neutral or negative) in the 2021 payment year.
In order to opt in or voluntarily report, you MUST log into the Quality Payment Program portal and select the applicable option.