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New G-Codes for Therapy Assistant Services Will Go into Effect October 5, 2020

Tiffany Karlin

October 01, 2020

The two new G-codes that describe therapy assistant services will go into effect on October 5th.

The CMS modified regulations to allow therapist assistants, rather than only therapists, to perform maintenance therapy under the Medicare HH benefit within the CY 2020 HH PPS final rule.

In order to track how much maintenance therapy is being furnished by therapist assistants in response to this regulatory change, the CMS established a G-code for the maintenance services furnished by a physical therapist assistant and a G-code for the maintenance services furnished by an occupational therapist assistant. The payment per visit will remain the same regardless of whether a therapist assistant is furnishing maintenance or other therapy services.

The two new G-codes are:

  1. G2168: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes
  2. G2169: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

Medicare systems will accept these claims when submitted after the implementation date of CR 11721 for dates of service on or after January 1, 2020. HHAs should:

• Report G2168 with revenue code 042x on HH claims (Type of Bill (TOB) 032x other than 0322)

• Report G2169 with revenue code 043x on HH claims TOB 032x other than 0322

Please make sure that your agency’s billing staff is aware of these changes.

Resources: Medicare Claims Processing Manual

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