G2143 HCPCS - FUNCTIONAL STATUS MEASURED BY THE OSWESTRY DISABILITY INDEX (ODI VERSION 2.1A) AT ONE YEAR (9 TO 15 MONTHS) POSTOPERATIVELY WAS GREATER THAN 22 AND 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 LESS THAN 30 POINTS

Code Information

HCPCS Code: G2143
Sequence Number: 0010
Short Description: Fs odi 9-15mo > 22
Long Description: Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and 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 less than 30 points
Date Added: 1/1/2020
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2022
Classification: Temporary Procedures & Professional Services
Coding System: HCPCS

Berenson-Eggers Type Of Service Code: Z2 - Undefined codes
Type Of Service Code:
- 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96

Pricing Indicator Code:
- 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
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')
Coverage Issues Manual Reference Section Number:
N/A
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: C - Carrier judgment

Field Name	Field Value
Healthcare Common Procedure Coding System Code	G2143
HCPCS Sequence Number	0010
HCPCS Record Identification Code	3 - First line of procedure record also contains detail information in positions 92-275
HCPCS Long Description	Functional status measured by the oswestry disability index (odi version 2.1a) at one year (9 to 15 months) postoperatively was greater than 22 and 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 less than 30 points
HCPCS Short Description	Fs odi 9-15mo > 22
HCPCS Pricing Indicator Code 1	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 Code	C - Carrier judgment
HCPCS Berenson-Eggers Type Of Service Code	Z2 - Undefined codes
HCPCS Type Of Service Code 1	1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
HCPCS Anesthesia Base Unit Quantity	0
HCPCS Code Added Date	1/1/2020
HCPCS Action Effective Date	1/1/2022
HCPCS Action Code	N - No maintenance for this code