Summary & Overview
HCPCS G2142: Oswestry Disability Index Postoperative Functional Assessment
HCPCS Level II code G2142 documents a standardized postoperative functional outcome assessment using the Oswestry Disability Index (ODI) version 2.1a at one year after spine surgery (9–15 months). The code indicates either an absolute ODI score of 22 or less, or a documented improvement of 30 points or more compared with a preoperative ODI measured within three months prior to surgery. Nationally, such functional outcome metrics are increasingly used to track surgical value, quality improvement, and payment accountability for spine procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise guidance on the clinical context for the measure, typical sites of service where it is captured, common modifiers associated with the service line, and which stakeholders commonly reference this metric. The publication summarizes benchmark-relevant concepts, policy implications for outcome-based reporting, and how G2142 fits within postoperative performance measurement frameworks.
Data not available in the input: detailed payer-specific reimbursement rates, associated taxonomies, ICD-10 diagnoses, and related billing codes.
Billing Code Overview
HCPCS Level II code G2142 describes measurement of functional status using the Oswestry Disability Index (ODI) version 2.1a at one year postoperatively (defined as 9 to 15 months) with results meeting either of two criteria: a score less than or equal to 22, or an improvement of 30 points or greater compared with a preoperative ODI measured within three months prior to surgery.
Service Type: Postoperative functional status assessment using a validated patient-reported outcome measure.
Typical Site of Service: Outpatient clinic or post-acute follow-up setting where standardized functional outcome instruments are administered and documented.
Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, and Related Codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70 year-old adult who underwent lumbar spine surgery for degenerative disc disease or lumbar radiculopathy. The patient completed the Oswestry Disability Index (ODI version 2.1a) preoperatively within three months of surgery and again at one year postoperatively (9–15 months). The clinical workflow includes: initial surgical evaluation and documentation of baseline ODI; perioperative care and rehabilitation; scheduling of a one-year outcome assessment visit; administration of the ODI questionnaire by clinic staff or via secure patient portal; scoring and documentation in the medical record; and comparison of baseline and one-year scores to determine whether the one-year ODI is ≤22 or there has been an improvement of ≥30 points from baseline. Results are used for outcome reporting, quality measurement, and may be submitted to payers or registries as required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to report or collect outcome measure exceeds typical and documentation supports additional work for scoring or complex record aggregation |
23 | Unusual anesthesia |