G9426 HCPCS: Reimbursement & Benchmarks | OpenPayer

Summary & Overview

HCPCS G9426: ED Pain Medication Timing Improvement

HCPCS Level II code G9426 denotes a quality measure for improvement in median time from emergency department (ED) arrival to initial ED oral or parenteral pain medication administration for patients admitted from the ED. As a performance-oriented HCPCS Level II code, G9426 captures timeliness of pain management — a metric with implications for patient experience, clinical quality, and hospital performance measurement at a national scale.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the typical setting (ED), and the service type (timeliness of initial analgesic administration for admitted ED patients). The publication also outlines common modifiers and metadata, and summarizes the clinical context for why median time-to-analgesia is monitored.

This summary provides benchmarks, coding context, and policy-relevant considerations such as payer coverage patterns and reporting expectations. It is intended for national audiences including health system administrators, coding and compliance professionals, and payers interested in emergency care quality measures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9426HCPCS Level IIEmergency DepartmentPain ManagementQuality MeasureTime-to-AnalgesiaED PerformanceHospital Reporting

Billing Code Overview

HCPCS Level II code G9426 denotes improvement in median time from ED arrival to initial ED oral or parenteral pain medication administration performed for ED admitted patients. This represents a performance or quality measure tied to timely pain management in the emergency department.

Service type: Emergency department quality measurement related to pain medication administration timing
Typical site of service: Emergency Department (ED)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to the emergency department with moderate-to-severe acute pain related to conditions such as flank pain from suspected nephrolithiasis, acute extremity fracture, acute abdominal pain, or acute exacerbation of sickle cell disease. The ED triage nurse documents initial pain score and triage category; the ED clinician evaluates the patient, orders analgesia, and documents indication and route (oral or parenteral). For ED-admitted patients the metric captured by G9426 measures improvement in the median time from ED arrival to administration of the first oral or parenteral analgesic given while the patient remains in the ED prior to hospital admission. Typical workflow steps include triage pain assessment, timely nursing or provider order entry for analgesic, medication administration with documentation of time and route in the electronic health record, reassessment of pain score, and disposition decision to admit. Usual site of service is the hospital emergency department; service type is a quality/performance measure tied to ED analgesia processes for admitted ED patients. Common real-world scenario: a 45-year-old with acute ureteral colic arrives at 08:12, triage documents pain 8/10, provider orders IV ketorolac and oral opioid alternatives; medication administration at 08:30 is recorded and used to compute median door-to-analgesia times for admitted patients.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS G8645: Intent to Report Asthma Measures Group

HCPCS-G0186-CHOROID-LESION-PHOTOCOAGULATION-FEEDER-VESSEL

HCPCS G0186: Photocoagulation for Localized Choroid Lesion, Feeder Vessel Technique

HCPCS-G9838-METASTATIC-DISEASE-AT-DIAGNOSIS

HCPCS G9838: Patient Has Metastatic Disease at Diagnosis

HCPCS-G9341-PRIOR-CT-SEARCH-EXTERNAL-ARCHIVE

HCPCS G9341: Search for Prior External CT Studies

HCPCS-G8420-BMI-NORMAL-NO-FOLLOW-UP-REQUIRED

HCPCS G8420: BMI Documented Normal, No Follow-Up Required

HCPCS-G9831-AJCC-STAGE-II-III-BREAST-CANCER-DIAGNOSIS

HCPCS G9831: AJCC Stage II or III at Breast Cancer Diagnosis

HCPCS-G8583-BETA-BLOCKER-CONTRAINDICATED

HCPCS G8583: Beta-blocker Contraindicated

HCPCS-G1005-CLINICAL-DECISION-SUPPORT-NATIONAL-IMAGING-ASSOCIATES

HCPCS G1005: Clinical Decision Support Mechanism for Imaging

HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G9160-SPOKEN-LANGUAGE-COMPREHENSION-FUNCTIONAL-STATUS

HCPCS G9160: Spoken Language Comprehension Functional Status

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`208D00000X`	Emergency Medicine	Primary specialty responsible for ED analgesia processes and measurement.
`208000000X`	Anesthesiology	Commonly consulted for severe pain management or procedural analgesia in the ED.
`367A00000X`	Nurse Practitioner - Acute Care	NPs working in ED who frequently order and administer analgesia.
`366A00000X`	Physician Assistant - Emergency Medicine	PAs who manage ED patients and document medication administration times.
`163W00000X`	Hospitalist	Hospitalists involved when ED-admitted patients transition to inpatient care and quality metrics include admitted cohort.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R52`	Pain, unspecified	Broad marker for patients presenting with acute pain where timely analgesia is indicated and measured.
`S52.5X0A`	Fracture of lower end of radius, initial encounter for closed fracture	Common injury causing acute severe pain in the ED and often requiring rapid analgesic administration prior to admission.
`N20.0`	Calculus of kidney	Nephrolithiasis frequently presents with severe flank pain; time-to-analgesia for admitted patients is tracked by this measure.
`M54.5`	Low back pain	Acute severe back pain presentations in ED where analgesia timing is relevant to patient comfort and measurement.
`D57.0`	Sickle-cell anemia with crisis	Acute vaso-occlusive crisis causes severe pain; prompt parenteral analgesia in the ED for admitted patients is a key clinical focus.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Acute abdominal pain etiologies that may prompt urgent analgesia pending admission and further workup.
`S72.001A`	Fracture of unspecified femur, initial encounter for closed fracture	Major traumatic pain requiring timely analgesia in the ED prior to admission.
`R10.9`	Abdominal pain, unspecified	Common ED presentation where measurement of door-to-analgesia time applies for admitted patients.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	May be performed for analgesia adjuncts or when IV fluids are required prior to or concurrently with parenteral analgesic administration in the ED.
`96361`	Intravenous infusion, each additional hour	Related when prolonged IV therapy accompanies analgesic management before admission.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; interpretation and report	Common diagnostic code performed in ED for chest pain presentations where analgesia timing is also tracked.
`29105`	Application of short arm splint (forearm, wrist)	Procedural adjunct often performed with analgesia for fractures or extremity injuries presenting in the ED.
`99283`	Emergency department visit for the evaluation and management of a patient, moderate severity	Typical E/M level for ED patients who receive timed analgesia and may be admitted; used in workflow documentation affecting measure cohort.
`99285`	Emergency department visit for the evaluation and management of a patient, high severity	Used for higher-acuity ED patients where rapid analgesia administration is critical and measured by `G9426`.

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