Summary & Overview
HCPCS G8395: Left Ventricular Ejection Fraction ≥40% or Normal/Mildly Depressed
HCPCS Level II code G8395 denotes documentation that a patient’s left ventricular ejection fraction (LVEF) is 40% or greater, or that left ventricular systolic function is normal or only mildly depressed. This clinical-status code supports quality measurement, care coordination, and appropriate clinical decision-making for heart failure and cardiology management across care settings. It matters nationally because accurate LVEF documentation influences treatment selection, performance measurement, and downstream utilization such as device therapy, medication titration, and transitions of care.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national context on clinical utility and coding purpose, plus an outline of common payer coverage considerations. The publication provides benchmarks and coding practice guidance, summarizes the clinical context for LVEF reporting, and highlights implications for care pathways and quality reporting. It also lists common modifiers and notes where additional clinical or administrative detail may be required by payers.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code G8395 documents left ventricular ejection fraction (LVEF) of 40% or greater or notation of normal or mildly depressed left ventricular systolic function. This code is used to record a clinical assessment of left ventricular systolic function rather than to report the imaging procedure itself.
Service Type: Cardiac function assessment / Echocardiographic interpretation or clinical measurement
Typical Site of Service: Outpatient cardiology clinics, hospital outpatient departments, imaging centers, and inpatient hospital settings where cardiac function is evaluated
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with a history of hypertension and ischemic heart disease presenting for routine cardiology follow-up after recent heart failure hospitalization. The clinician documents functional status, reviews prior echocardiogram results, and confirms left ventricular ejection fraction (LVEF) is normal or mildly depressed (LVEF ≥ 40%) based on transthoracic echocardiography performed in the outpatient imaging suite. The workflow includes review of the imaging report, reconciliation of medications (especially guideline-directed heart failure therapies), documentation of LVEF as “≥ 40%” or “normal/mildly depressed left ventricular systolic function,” and coding/billing staff assigning HCPCS Level II code G8395 to indicate preserved or mildly reduced systolic function. Typical site of service is outpatient cardiology clinic or hospital outpatient imaging center. The patient encounter may be part of quality reporting or registry documentation that tracks ejection fraction categories for heart failure management and discharge planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when physician documents substantially greater work than typical for the encounter (e.g., complex diagnostic review, extended consultation). |