HCPCS Code G9507
Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
| Short Description | Doc reas on statin or contra |
|---|---|
| Year | 2026 |
| Coverage Code | C = Carrier judgment |
| Action Code | N = No maintenance for this code |
| Action Effective Date | January 01, 2016 |
| Code Added Date | January 01, 2016 |
| Pricing Indicator | 00 = Service not separately priced by Part B (e.g., services not covered, bundled, used by part a only, etc.) |
| Type of Service | 1 = Medical care |