OTA 206: Hum. Occ._ Section GG Medicare Functional Assessment Vocabulary
Overview of Section GG Medicare Functional Assessment
Context & Regulatory Framework: Section GG is a standardized functional assessment tool utilized across all post-acute care (PAC) settings by the Centers for Medicare & Medicaid Services (CMS). It was established under data standardization requirements (including the IMPACT Act of 2014) to harmonize functional outcome data across healthcare environments.
Clinical Scope & Interdisciplinary Nature: Although all items within Section GG fall directly within the Occupational Therapy (OT) scope of practice, Section GG is designed as an interdisciplinary assessment instrument. Other standardized clinical evaluations can and should be used alongside Section GG during a comprehensive evaluation.
Professional Advocacy: The American Occupational Therapy Association (AOTA) encourages practitioners to leverage Section GG assessment data as a vital advocacy tool to demonstrate the distinct value of occupational therapy in post-acute care.
Cross-Setting PAC Assessment Integration: Section GG items correspond directly to standardized functional items across four major Medicare PAC assessment instruments:
Minimum Data Set (MDS): Utilized in Skilled Nursing Facilities (SNFs).
Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI): Utilized in Inpatient Rehabilitation Facilities (IRFs).
Long Term Care Hospital Continuity Assessment Record Evaluation Tool (LTCH CARE / LCDS): Utilized in Long Term Care Hospitals (LTCHs).
Outcome and Assessment Information Set (OASIS): Utilized in Home Health Agencies (HHAs).
Client Identification & Administrative Data
Client: Full name of the client/patient.
DX: Primary and secondary medical diagnosis/diagnoses.
MRN: Medical Record Number.
Eval Date: Date of initial evaluation.
DC Date: Date of discharge.
Prior Functioning & Prior Device Use
Prior Functioning: Everyday Activities (Assessment Item GG 0100)
Purpose: Assesses the patient's baseline functional status and assistance needs prior to the current illness, exacerbation, or injury.
Prior Functioning Code Key:
3= Independent2= Need Some Help3= Dependent8= Unknown9= Not Applicable
Item Definitions:
A. Self-care: The ability to use suitable utensils to bring food to the mouth and swallow food or liquid once the meal is placed before the patient.
B. Indoor mobility (ambulation): The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment.
C. Stairs: Code the patient’s need for assistance with internal or external stairs (with or without a device such as a cane, crutch, or walker) prior to the current illness, exacerbation, or injury.
D. Functional cognition: Code the patient’s need for assistance with planning regular tasks, such as shopping or remembering to take medication prior to the current illness, exacerbation, or injury.
Prior Device Use (Assessment Item GG 0110)
Purpose: Identifies all devices and assistive aids used by the patient/resident prior to the current illness, exacerbation, or injury (check all that apply):
A: Manual wheelchair
B: Motorized wheelchair and/or scooter
C: Mechanical lift
D: Walker
E: Orthotics/ prosthetics
Z: None of the above
Functional Limitation in Range of Motion (Assessment Item GG 0115)
Usage Note: Currently utilized only on the Minimum Data Set (MDS).
Purpose: Codes for range of motion limitations that interfered with daily functions or placed the resident at risk of injury in the last 7 days:
A. Upper extremity: Shoulder, elbow, wrist, hand
B. Lower extremity: Hip, knee, ankle, foot
Mobility Devices (Assessment Item GG 0120)
Usage Note: Currently utilized only on the Minimum Data Set (MDS).
Purpose: Identifies all mobility devices normally used in the last 7 days (check all that apply):
A: Cane/ crutch
B: Walker
C: Wheelchair (manual or electric)
D: Limb prosthesis
Z: None of the above were used
Performance Scoring Scale & Coding Definitions
Performance Rating Scale (Codes 01 – 06)
6 = Independent: Patient/resident safely completes the activity by themselves with no assistance from a helper. Adaptive equipment and assistive devices may be used.
5 = Setup or Cleanup Assistance: Helper sets up or cleans up; patient/resident completes activity. Helper assists only prior to or following the activity.
4 = Supervision or Touching Assistance: Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as patient/resident completes activity. Assistance may be provided throughout the activity or intermittently.
3 = Partial/Moderate Assistance: Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.
2 = Substantial/Maximal Assistance: Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.
1 = Dependent: Helper does ALL the effort. Patient/resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient/resident to complete the activity.
Non-Performance & Special Coding Options
07 = Refused: Resident refused to perform the activity.
09 = Not Applicable: Resident did not perform this activity prior to current illness, exacerbation, or injury.
10 = Not Attempted: Activity was not attempted due to environmental limitations.
88 = Not Attempted: Activity was not attempted due to medical condition and safety concerns.
Core Rating Principles
Baseline Functional Assessment: Admission GG scores should reflect functional status prior to the benefit of services to capture the client's true baseline.
Assessment Intervals: Functional levels are documented across three distinct intervals: Admission, Goal, and Discharge.
Assistive Technology Rule: Adaptive equipment and assistive devices may be used for any score level without downgrading the patient to a lower score.
Self-Care Assessment Items (Assessment Items GG 0130)
Item Breakdown & Specific Definitions:
GG 0130A — Eating: The ability to use suitable utensils to bring food to the mouth and swallow food or liquid once the meal is placed before the patient.
GG 0130B — Oral hygiene: The ability to use suitable items to clean teeth. Dentures (if applicable): The ability to insert and remove dentures into and from the mouth, and manage denture soaking and rinsing with use of equipment.
GG 0130C — Toileting hygiene: The ability to maintain perineal hygiene, adjust clothing before and after voiding or having a bowel movement. If managing an ostomy, include wiping the opening but not managing equipment.
GG 0130D — Wash upper body: The ability to wash, rinse, and dry the face, hands, chest, and arms while sitting in a chair or bed. (Note: Item is reported to CMS only in Long Term Care Hospitals [LTCH]).
GG 0130E — Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0130F — Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0130G — Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.
GG 0130H — Putting on/ taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable.
GG 0130I — Personal hygiene: The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands (excludes baths, showers, and oral hygiene). (Note: Item is reported to CMS only on the MDS).
Mobility Assessment Items (Assessment Items GG 0170)
Item Breakdown & Specific Definitions:
GG 0170A — Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back on the bed.
GG 0170B — Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.
GG 0170C — Lying to sitting on side of bed: The ability to safely move from lying on the back to sitting on the side of the bed with feet flat on the floor, and with no back support.
GG 0170D — Sit to stand: The ability to safely come to a standing position from sitting in a chair or on the side of the bed.
GG 0170E — Chair/bed-to-chair transfer: The ability to safely transfer to and from a bed to a chair (or wheelchair).
GG 0170F — Toilet transfer: The ability to safely get on and off a toilet or commode.
GG 0170FF — Tub/ shower transfer: The ability to get in and out of a tub/shower. (Note: Item is reported to CMS only on the MDS).
GG 0170G — Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170I — Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space. Skip Logic: If performance is coded 07, 09, 10, or 88, skip to M (1 step curb).
GG 0170J — Walk 50 feet with 2 turns: Once standing, the ability to walk at least 50 feet and make two turns.
GG 0170K — Walk 150 feet: Once standing, the ability to walk at least 150 feet in a corridor or similar space. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170L — Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.
GG 0170M — 1 step (curb): Can score if using wheelchair. The ability to go up and down a curb and/or up and down one step. Skip Logic: If performance is coded 07, 09, 10, or 88, skip to P (picking up object). (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170N — 4 steps: Can score if using wheelchair. The ability to go up and down four steps with or without a rail. Skip Logic: If performance is coded 07, 09, 10, or 88, skip to P (picking up object). (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170O — 12 steps: Can score if using wheelchair. The ability to go up and down 12 steps with or without a rail. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170P — Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon, from the floor. (Note: Item is not reported to CMS in Long Term Care Hospitals [LTCH]).
GG 0170Q — Wheelchair/scooter screening: Does patient use wheelchair and/ or scooter? Checkboxes:
No/Yes. Skip Logic: Skip items R and S if response is No.GG 0170R — Wheel 50 feet with 2 turns: Once seated in wheelchair/scooter, can wheel at least 50 feet and make two turns. Checkboxes:
manual/motorized.GG 0170S — Wheel 150 feet: Once seated in wheelchair/scooter, can wheel at least 150 feet in a corridor or similar space. Checkboxes:
manual/motorized.
Section GG Decision Tree & Scoring Algorithm
Sequential Decision Tree Logic:
Step 1: Does the patient/resident complete the activity—with or without assistive devices—by themselves and with no assistance (physical, verbal/nonverbal cueing, setup/clean-up) from a helper?
YES Code 6: Independent
NO Proceed to Step 2
Step 2: Does the patient/resident need only setup/clean-up assistance from one helper only prior to or following the activity?
YES Code 5: Setup or Cleanup Assistance
NO $ ightarrow$ Proceed to Step 3
Step 3: Does the patient/resident need only verbal/nonverbal cueing or steadying/touching/contact guard assistance from one helper? (Assistance may be throughout or intermittently).
YES $ ightarrow$ Code 4: Supervision or Touching Assistance
NO $ ightarrow$ Proceed to Step 4
Step 4: Does the patient/resident need physical assistance—for example lifting or trunk support—from one helper, with the helper providing less than half of the effort?
YES $ ightarrow$ Code 3: Partial/Moderate Assistance
NO $ ightarrow$ Proceed to Step 5
Step 5: Does the patient/resident need physical assistance—for example lifting or trunk support—from one helper with the helper providing more than half of the effort?
YES $ ightarrow$ Code 2: Substantial/Maximal Assistance
NO $ ightarrow$ Evaluate Dependency Criteria:
Does the helper need to do 100% of the task? OR Are 2 or more helpers needed at any time?
YES $ ightarrow$ Code 1: Dependent