Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesPatient HistoryCPT cpt-1126f-cancer-pain-severity-measurement-no-pain-reported
    Ask Trek AI about this page

    CPT 1126F: Pain Severity Assessment for Cancer Therapy

    CPT code 1126F documents that a provider measured the severity of pain in a patient with cancer receiving chemotherapy or radiotherapy during the measurement period; the code is reported when the patient does not experience pain. Service type: symptom assessment/clinical measurement. Typical site of service: oncology clinic, infusion center, or radiation therapy facility.

    For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.

    Customize your policy alerts

    Sign up for cpt 1126F policy alerts

    Get alerted when payer policies referencing 1126F are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with metastatic colon cancer receiving systemic chemotherapy presents for a routine oncology treatment visit in an outpatient infusion center. The oncology nurse or clinician performs a standardized pain assessment during the chemotherapy visit using a validated pain scale (for example 0–10 numeric rating scale). The encounter documents that the patient does not experience pain during the measurement period. The assessment and documentation are recorded in the ambulatory infusion center medical record and used for quality measurement and reporting. Typical site of service is an outpatient oncology clinic or infusion center. Service type is clinical quality measurement/assessment of pain severity for a patient receiving chemotherapy or radiotherapy during the measurement period. Common modifiers that may be applied when billing include 95 and KX depending on payer requirements and reporting context.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99211Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physicianLow-acuity visit that may include documentation of pain assessment for a chemotherapy patient when billed separately
    99212Office or other outpatient visit for an established patient, typically 10 minutesBrief E/M visit that can accompany a pain assessment when counseling or medication management is provided
    99213Office or other outpatient visit for an established patient, typically 15 minutesCommon E/M level when pain assessment leads to treatment changes or care coordination
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourRepresents chemotherapy infusion services during which pain severity is assessed as part of routine monitoring
    G0463Hospital outpatient clinic visit for assessment and management of a patientFacility clinic visit code for outpatient oncology centers that may include pain severity measurement
    99406Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutesExample of a counseling service that may be documented alongside pain assessment in supportive care visits

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    363LP0200XPediatric Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    261QP2300XPrimary Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    2471Q0001XQuality Management Radiologic TechnologistA radiologic technologist who specializes in quality management.
    261QP0904XFederal Public Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    202C00000XIndependent Medical Examiner PhysicianA special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practiti…
    2279P1005XPulmonary Rehabilitation Registered Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…

    Related Payer Policy Updates

    Specialty: Obstetrics/Gynecology1 / 3

    8 rows

    PolicyPayerEffective Date
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Prolonged Services for Labor ManagementPremera Bluecross2027-01-01
    Cervical Cancer ScreeningOscar Health2026-10-01
    Prenatal Testing for Fetal AneuploidyOscar Health2026-10-01
    Diagnosis of VaginitisOscar Health2026-10-01
    Prenatal Screening (Nongenetic)Oscar Health2026-10-01
    View PDF of Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes, Effective 10/1/2026 in MedicalBlue Cross Blue Shield - Rhode Island2026-10-01
    Maternal Serum Testing for Prediction of Adverse Obstetric OutcomesBluecross Idaho2026-09-01

    Related Codes

    CPT-1000F-CATEGORY-II-PERFORMANCE-MEASURE

    CPT 1000F: Tobacco Use Status Assessment

    CPT-1002F-NO-SUMMARY-AVAILABLE

    CPT 1002F: No Summary available

    CPT-1003F-PERFORMANCE-MEASURE

    CPT 1003F: Preventive Care Tobacco Use Counseling

    CPT-1004F-NO-SUMMARY-AVAILABLE

    CPT 1004F: Health Status Assessment

    CPT-1005F-NO-SUMMARY-AVAILABLE

    CPT 1005F: Peripheral Oxygen Saturation Assessment

    CPT-1006F-BRIEF-SUMMARY-NOT-AVAILABLE

    CPT 1006F: No Summary Available

    CPT-1007F-NO-SUMMARY-AVAILABLE

    CPT 1007F: Influenza Vaccination Administered

    CPT-1008F-UNSPECIFIED-SERVICE

    CPT 1008F: Depression Screening, Brief Standardized Assessment

    CPT-1010F-ANGINA-SEVERITY-ASSESSMENT-CAD-ACTIVITY-RESPONSE

    CPT 1010F: Angina Activity Assessment in Coronary Artery Disease

    CPT-1011F-THERAPEUTIC-MANAGEMENT-CORONARY-ARTERY-DISEASE-ANGINA

    CPT 1011F: Therapeutic Management for CAD with Angina

    Showing 1–10 of 81

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.