G9580 Door-to-Puncture Benchmarks & Policy | OpenPayer

Summary & Overview

HCPCS G9580: Door to puncture time of 90 minutes or less

HCPCS Level II code G9580 denotes the performance measure “Door to puncture time of 90 minutes or less,” addressing the timeliness of initiating endovascular thrombectomy for acute ischemic stroke. National attention on time-to-treatment for stroke makes this code important for hospital quality reporting and payer performance metrics, as rapid reperfusion correlates with improved patient outcomes and reduced disability.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the measure, how it maps to hospital emergency department and interventional services, and which stakeholders typically apply or monitor the measure. The publication outlines benchmarking considerations and policy implications relevant to national payer programs and hospital quality initiatives.

The report provides benchmarks where available, highlights policy updates and reporting expectations tied to acute stroke performance, and situates G9580 within clinical workflows that prioritize rapid door-to-puncture performance. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9580HCPCS Level IIacute ischemic strokeendovascular thrombectomydoor-to-puncturehospital qualitytimeliness measuresstroke performance

Billing Code Overview

HCPCS Level II code G9580 represents Door to puncture time of 90 minutes or less. This measure captures the timeliness of endovascular treatment initiation for eligible patients presenting with acute ischemic stroke.

Service type: Time-based acute stroke performance measure, focused on rapid initiation of endovascular thrombectomy
Typical site of service: Hospital emergency department and interventional radiology / endovascular suite

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents to the emergency department with acute onset right-sided weakness and aphasia beginning 45 minutes earlier. Emergency medical services prenotify the stroke center. On arrival the patient undergoes rapid triage, immediate non-contrast head CT to exclude hemorrhage, vascular imaging (CT angiography) demonstrating a left middle cerebral artery large vessel occlusion, and NIH Stroke Scale assessment. The stroke team activates the neurointerventional suite, obtains informed consent from a proxy, and prepares for endovascular thrombectomy. Door time (hospital arrival) to arterial puncture is achieved in 78 minutes, meeting the performance measure represented by G9580 (door to puncture time of 90 minutes or less). Typical workflow steps include ED triage and stroke activation, emergent imaging, eligibility assessment for thrombectomy and intravenous thrombolysis, transfer to angiography suite, anesthesia evaluation (local with monitored anesthesia care or general anesthesia), arterial access and groin preparation, and mechanical thrombectomy performed by an endovascular specialist.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or intensity substantially exceeds typical for the assigned CPT procedures associated with endovascular thrombectomy.

HCPCS G9497: Preoperative Instruction to Abstain from Smoking

HCPCS-G2066-REMOTE-IMPLANTABLE-LOOP-RECORDER-MONITORING

HCPCS G2066: Remote Interrogation for Implantable Cardiac Monitors

HCPCS-G9529-HEAD-TRAUMA-APPROPRIATE-INDICATION-HEAD-CT

HCPCS G9529: Minor Blunt Head Trauma, Appropriate Indication for Head CT

HCPCS-G9775-MULTI-CLASS-ANTI-EMETIC-PROPHYLAXIS-PERIOPERATIVE

HCPCS G9775: Multi-Class Prophylactic Anti-Emetic Administration

HCPCS-G8858-OTOLOGIC-REFERRAL-NOT-PERFORMED

HCPCS G8858: Referral for Otologic Evaluation Not Performed

HCPCS-G0570-BEHAVIORAL-HEALTH-CARE-MANAGEMENT-MONTHLY

HCPCS G0570: Behavioral Health Care Management, Monthly

HCPCS-G9169-MEMORY-FUNCTIONAL-LIMITATION-THERAPY-REPORTING

HCPCS G9169: Memory Functional Limitation, Episode Reporting

HCPCS-G8495-CKD-MEASURES-COMPLETE

HCPCS G8495: Completion of CKD Quality Measures Bundle

HCPCS-G2076-INTAKE-CARE-PLANNING-OPIOID-TREATMENT

HCPCS G2076: Intake and Care Planning for Opioid Treatment Programs

HCPCS-G0278-ILIAC-FEMORAL-ARTERY-ANGIOGRAPHY-ADJUNCT-CARDIAC-CATHETERIZATION

HCPCS G0278: Iliac/Femoral Artery Angiography Adjunct to Cardiac Catheterization

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2084P0800X`	Neurology	Vascular neurologists lead acute stroke evaluation and triage.
`2086S0102X`	Vascular and Interventional Neurology	Specialists who perform or direct endovascular stroke therapies.
`231H00000X`	Radiology – Diagnostic	Neuroradiologists provide emergent CTA interpretation.
`1744S0800X`	Radiology – Interventional Neuroradiology	Interventional radiologists / endovascular neurosurgeons performing thrombectomy.
`207P00000X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia for complex cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I63.031`	Cerebral infarction due to thrombosis of left middle cerebral artery	Large vessel occlusion commonly treated with mechanical thrombectomy; directly relevant to door-to-puncture timing metrics.
`I63.111`	Cerebral infarction due to embolism of right middle cerebral artery	Embolic large vessel occlusions are an indication for endovascular thrombectomy when within time and imaging criteria.
`I63.9`	Cerebral infarction, unspecified	Used when stroke subtype not yet fully determined; still may require urgent endovascular evaluation.
`I67.89`	Other specified cerebrovascular disease	Vascular conditions that may complicate or contribute to ischemic stroke and procedural planning.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIA may precede or mimic stroke; rapid evaluation determines need for emergent imaging and possible intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61645`	Endovascular thrombectomy, intracranial, for acute ischemic stroke; arterial catheterization, selective catheter angiography with thrombectomy devices	Primary procedural codes for mechanical thrombectomy performed to remove thrombus from intracranial vessels during the same encounter.
`36215`	Selective catheter placement, each first order thoracic, abdominal, or pelvic branch (used for vascular access and diagnostic catheterization during neuroendovascular procedures)	Used for arterial access and selective catheterization of cerebral vessels as part of angiographic evaluation before thrombectomy.
`37184`	Endovascular mechanical thrombectomy, non-coronary, percutaneous, including distal embolic protection when performed	Used in some reporting contexts for peripheral or non-coronary intracranial thrombectomy techniques when applicable per payer guidance.
`70496`	CT angiography, head/neck, with contrast, including image postprocessing	Performed emergently to identify large vessel occlusion and guide eligibility for thrombectomy prior to the procedure.
`43220`	Diagnostic catheterization of intracranial vessels (Note: use the appropriate intracranial angiography CPT when indicated)	Represents diagnostic cerebral angiography performed as part of procedure planning and intra-procedural assessment.

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