Summary & Overview
HCPCS Level II M1042: Oswestry Disability Index Preop and 1-Year Postop
HCPCS Level II code M1042 denotes collection of the Oswestry Disability Index (ODI v2.1a) score preoperatively (within three months) and at one year postoperatively (9–15 months). This code captures longitudinal patient-reported functional outcome measurement for spine-related care and rehabilitation pathways. Nationally, standardized outcome measurement supports quality monitoring, care coordination, and value-based payment models by documenting functional change after intervention.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the measure, expected sites where the service is performed (preoperative and postoperative outpatient visits), and what the code documents in perioperative pathways. The publication outlines common benchmarks for reporting this outcome, relevant policy considerations for documentation and timing, and implications for quality reporting programs and bundled payment arrangements. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, related codes, or payer-specific coverage rules is noted as unavailable. The summary equips clinicians, billing professionals, and policy analysts with a concise national overview of the code’s role in tracking functional recovery after spine procedures.
Billing Code Overview
HCPCS Level II code M1042 represents a functional status measurement using the Oswestry Disability Index (ODI version 2.1a) patient-reported outcome tool. The service documents that a score was obtained within three months preoperatively and again at one year (9 to 15 months) postoperatively.
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Service type: Patient-reported outcome measurement for functional status monitoring
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Typical site of service: Preoperative and postoperative clinic visits or outpatient evaluation settings where patient-reported outcomes are collected
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient with chronic low back pain from degenerative lumbar disc disease is scheduled for elective lumbar decompression and fusion. Preoperative evaluation includes a baseline patient-reported outcome using the Oswestry Disability Index (ODI version 2.1a) completed within three months prior to surgery. Surgical consent, anesthesia assessment, and physical therapy planning reference the baseline ODI score. Postoperative follow-up includes routine clinical visits and a mandated outcome assessment window at one year (9 to 15 months) after surgery, when the ODI version 2.1a is administered again to measure functional improvement and document surgical effectiveness. Clinical workflow steps: intake and registration, administration of ODI via paper or electronic portal, scoring and entry into the medical record, clinician review during preoperative and postoperative visits, and documentation of ODI scores and dates to support billing of M1042 for both the preoperative and one-year postoperative assessments as specified.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use when an E/M unrelated to the index surgery is provided during the global period alongside ODI assessment documentation |