Summary & Overview
CPT 1126F: Cancer Pain Severity Measurement, No Pain Reported
CPT code 1126F captures documentation that a provider assessed the severity of pain in a patient with cancer who received chemotherapy or radiotherapy during the measurement period and that the patient did not experience pain. This performance-measure-oriented code is used in oncology care to record absence of pain among patients undergoing active cancer-directed therapy. Nationally, consistent use of such measure codes supports quality reporting, symptom management tracking, and program-level monitoring of supportive oncology care.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical intent and service context, guidance on typical settings where the code applies, and an overview of the types of benchmarks and policy topics commonly associated with performance-measure codes: measure definitions, documentation expectations, and payer coverage patterns. Data not available in the input is noted where applicable.
This publication is intended to orient clinicians, revenue staff, and policy analysts to the purpose and application context of CPT code 1126F, clarifying what the code represents and where it is typically reported within oncology practice workflows.
Billing Code Overview
CPT code 1126F documents that the provider measures the severity of pain in a patient with cancer who receives chemotherapy or radiotherapy during the measurement period. Report this code when a patient receiving chemotherapy or radiotherapy does not experience pain during the measurement period.
Service type: Symptom assessment and severity measurement tied to oncology care
Typical site of service: Oncology clinic or infusion center where patients receive chemotherapy or radiotherapy
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
95 | Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system | Use when the pain severity assessment is performed via a live telemedicine visit in lieu of in-person assessment for the chemotherapy- or radiotherapy-treated patient |
KX | Requirements specified in the medical policy are met | Use when payer requires attestation that medical necessity or policy conditions for measurement/reporting are satisfied |
24 | Unrelated evaluation and management service by the same physician during a postoperative period | Use if an unrelated E/M is provided the same day as a pain assessment when global period rules apply |
25 | Significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service | Use when a distinct E/M visit is provided in addition to the pain assessment |
59 | Distinct procedural service | Use when billing a distinct service that is separate from other procedures on the same day |
76 | Repeat procedure or service by same physician | Use if a pain assessment is repeated and billed again on the same day for a valid clinical reason |
77 | Repeat procedure by another physician | Use when another physician repeats the pain assessment during the same encounter |
91 | Repeat clinical diagnostic laboratory test | Rarely applicable; use only if a repeat objective pain-related test is billed under laboratory rules |
GT | Via interactive audio and video telecommunications systems (payer-specific) | Use when payer recognizes GT for telehealth pain assessment instead of 95 |
XE | Separate encounter, distinct from other services | Use when the assessment represents a separate encounter distinct from other services billed that day |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Medical Oncology | Primary specialty managing chemotherapy-treated patients and documenting pain assessments in infusion settings |
363LP0200X | Hematology-Oncology | Combined specialty providing chemotherapy and symptom assessments including pain |
261QM0800X | Pain Medicine | Specialty involved when pain is present or when specialized pain assessment is required |
207K00000X | Radiation Oncology | Specialty managing patients receiving radiotherapy and performing pain severity assessments |
261QP2300X | Palliative Medicine | Specialty focused on symptom control and routine pain measurement for oncology patients |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C18.7 | Malignant neoplasm of sigmoid colon | Common primary cancer diagnosis for patients receiving systemic chemotherapy where pain severity monitoring is relevant |
C34.90 | Malignant neoplasm of unspecified part of right or left bronchus or lung, unspecified | Lung cancer patients frequently receive chemotherapy or radiotherapy and require routine pain assessment |
C50.912 | Malignant neoplasm of unspecified site of right female breast | Breast cancer patients on systemic therapy commonly have pain surveillance during treatment |
C79.51 | Secondary malignant neoplasm of bone | Bone metastases often cause pain; monitoring severity during systemic therapy is clinically important |
Z51.11 | Encounter for antineoplastic chemotherapy | Designates the encounter for chemotherapy administration during which pain severity is measured |
Z51.0 | Encounter for radiotherapy | Designates radiotherapy encounters where pain assessment is part of routine symptom monitoring |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99211 | Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician | Low-acuity visit that may include documentation of pain assessment for a chemotherapy patient when billed separately |
99212 | Office or other outpatient visit for an established patient, typically 10 minutes | Brief E/M visit that can accompany a pain assessment when counseling or medication management is provided |
99213 | Office or other outpatient visit for an established patient, typically 15 minutes | Common E/M level when pain assessment leads to treatment changes or care coordination |
96365 | Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour | Represents chemotherapy infusion services during which pain severity is assessed as part of routine monitoring |
G0463 | Hospital outpatient clinic visit for assessment and management of a patient | Facility clinic visit code for outpatient oncology centers that may include pain severity measurement |
99406 | Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes | Example of a counseling service that may be documented alongside pain assessment in supportive care visits |