G8543 HCPCS code: Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
G8543 is the HCPCS Level II code for documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | M5D |
| Added | 2009-01-01 |
| Last action effective | 2023-01-01 |
What changed for G8543
- 2009-01-01: G8543 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G8543?
G8543 is the HCPCS Level II code for documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given. Short descriptor: "Cur funct asses; no care pln".
Does Medicare cover G8543?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G85 codes
- G8500 — All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
- G8501 — All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
- G8502 — All quality actions for the applicable measures in the back pain measures group have been performed for this patient
- G8506 — Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
- G8509 — Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
- G8510 — Screening for depression is documented as negative, a follow-up plan is not required
- G8511 — Screening for depression documented as positive, follow-up plan not documented, reason not given
- G8530 — Autogenous av fistula received
- G8531 — Clinician documented that patient was not an eligible candidate for autogenous av fistula
- G8532 — Clinician documented that patient received vascular access other than autogenous av fistula, reason not given
- G8535 — Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status
- G8536 — No documentation of an elder maltreatment screen, reason not given
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G8543
- Watch G8543 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8543
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.