G8926 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G8926: Spirometry Test Not Performed or Documented

HCPCS Level II code G8926 is used when a spirometry test was not performed or documented and no reason is provided. Spirometry is a key objective measure for diagnosing and managing obstructive and restrictive lung diseases; documenting its absence has implications for quality reporting, clinical follow-up, and claims adjudication. Nationally, use of a non-performance code such as G8926 signals gaps in captured pulmonary function testing or documentation processes.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning, typical service setting, and implications for billing and quality measurement. The publication outlines common modifiers seen with this service type, notes on payer handling where available, and related administrative considerations.

This summary prepares clinicians, coders, and policy stakeholders to understand where G8926 fits in claims workflows, how its presence may affect reporting and follow-up, and what content to seek in accompanying documentation. Data not available in the input is noted where relevant; the document focuses on national-level context rather than state-specific policy.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareG8926HCPCS Level IIspirometrypulmonary functionbillingquality reportingoutpatientclaims documentation

Billing Code Overview

HCPCS Level II code G8926 indicates that a spirometry test was not performed or documented, reason not given. This code reflects the absence of a completed spirometry service when one would otherwise be expected based on clinical care or quality reporting requirements.

Service type: Pulmonary function assessment (spirometry) not completed
Typical site of service: Outpatient clinic or office-based pulmonary/primary care setting where spirometry would normally be performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with chronic obstructive pulmonary disease (COPD) presents to a pulmonary clinic for routine assessment of lung function. The clinician intends to obtain spirometry to document FEV1, FVC, and bronchodilator response but the spirometry test is not performed or documented during the visit; no reason is recorded in the medical record. Typical workflow: the clinician documents the visit and orders or plans spirometry; the patient may be referred to the office pulmonary function lab or an external testing center; scheduling or patient factors sometimes delay testing. When testing is not completed and no reason is documented, billing uses the HCPCS Level II code G8926 to indicate the spirometry test was not performed or not documented and no reason is given. Typical site of service: outpatient clinic or office-based pulmonary function laboratory. Typical patient scenario: established COPD or asthma follow-up visit where spirometric confirmation or monitoring was expected but not completed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to document or attempt spirometry was substantially greater than typical (rare for `G8926`).

HCPCS G8781: Documentation of Medical Reason for No Diet or Activity Counseling

HCPCS-G0398-HOME-SLEEP-STUDY-TYPE-II-PORTABLE-MONITOR

HCPCS G0398: Home Sleep Study with Type II Portable Monitor

HCPCS-G6020-COLONOSCOPY-THROUGH-STOMA-STENT-PLACEMENT

HCPCS G6020: Colonoscopy Through Stoma with Transendoscopic Stent Placement

HCPCS-G8951-PRE-HYPERTENSIVE-OR-HYPERTENSIVE-BP-FOLLOW-UP-NOT-ELIGIBLE

HCPCS G8951: Pre-hypertensive or Hypertensive BP Reading, Follow-up Not Eligible

HCPCS-G0023-ILLNESS-NAVIGATION-CARE-COORDINATION-AUXILIARY-PERSONNEL

HCPCS G0023: Illness Navigation and Care Coordination, Auxiliary Personnel

HCPCS-G9326-CT-NOT-REPORTED-TO-DOSE-REGISTRY

HCPCS G9326: CT Studies Not Reported to Dose Index Registry

HCPCS-G9102-GASTRIC-ADENOCARCINOMA-DISEASE-STATUS-ASSESSMENT

HCPCS G9102: Gastric Adenocarcinoma Disease Status Assessment

HCPCS-G0121-COLONOSCOPY-SCREENING-AVERAGE-RISK

HCPCS G0121: Colonoscopy for Average-Risk Colorectal Cancer Screening

HCPCS-G9646-90-DAY-MRS-0-2-FUNCTIONAL-OUTCOME

HCPCS G9646: 90-Day mRS 0–2 Functional Outcome

HCPCS-G9362-MONITORED-ANESTHESIA-CARE-PERIPHERAL-NERVE-BLOCK-DURATION-60-MINUTES-OR-LONGER

HCPCS G9362: Duration of MAC or Peripheral Nerve Block ≥60 Minutes

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RP1001X`	Pulmonary Disease	Pulmonologists commonly order and interpret spirometry.
`208D00000X`	Internal Medicine	Primary care physicians frequently request spirometry for COPD/asthma management.
`363LP0200X`	Respiratory Therapy	Respiratory therapists perform spirometry testing in many settings.
`367A00000X`	Nurse Practitioner	NPs in primary care or pulmonology clinics may manage and document testing.
`363A00000X`	Clinical Laboratory Director	Laboratory directors oversee pulmonary function labs and quality control.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`94010`	Bronchospasm evaluation; spirometry as in-office or bedside screening (may include simple spirometry)	Commonly performed alongside or in place of full diagnostic spirometry; may be billed when basic spirometric measures are obtained.
`94060`	Bronchodilator responsiveness, spirometry as in-office or bedside pre- and post-bronchodilator evaluation	Performed when assessing bronchodilator response; typically follows baseline spirometry.
`94375`	Respiratory mechanics, spirometry for diagnostic purposes, includes FEV1 and FVC	Used for diagnostic spirometry in pulmonary function labs; would normally accompany visits where `G8926` indicates testing was expected but not completed.
`94620`	Continuous positive airway pressure (CPAP) initiation and management — typically for home use	Often part of broader respiratory care plans; may be ordered based on spirometry results.
`94729`	Unlisted pulmonary service or procedure	Used for pulmonary testing not described by other CPT codes; rarely used when documentation is incomplete.

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