2024 HCPCS Code G2142

Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was less than or equal to 22 or functional status measured by the odi version 2.1a within three months preoperatively and at one year (9 to 15 months) postoperatively demonstrated an improvement of 30 points or greater

Short Description	Fs odi 9-15mo postop<= 22
HCPCS Coverage Code	C - Carrier judgment
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2022
HCPCS Code Added Date	January 01, 2020
HCPCS Pricing Indicator Code	00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
HCPCS Multiple Pricing Indicator Code	9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
HCPCS Coverage Issues Manual Reference Section Number
HCPCS Type Of Service Code	1 - Medical care
HCPCS Anesthesia Base Unit Quantity	0