Summary & Overview
HCPCS G8476: Blood Pressure Controlled, <140/<90
HCPCS Level II code G8476 documents that a patient’s most recent blood pressure is controlled, with a systolic measurement under 140 mmHg and a diastolic measurement under 90 mmHg. This status code is used in outpatient and office settings to indicate blood pressure control, supporting quality measurement, care documentation, and population health tracking across practices. Nationally, blood pressure control is a common quality metric tied to chronic disease management and pay-for-performance programs, making accurate use of this code relevant for clinicians and administrators.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning, typical settings of use, and the types of reporting and benchmarking contexts where G8476 appears. The publication also summarizes how this code fits into clinical workflows and quality measurement frameworks, and identifies where input data is not available when applicable. This briefing is written for a national audience and focuses on the code’s purpose, implications for documentation and reporting, and the contexts in which it is commonly applied.
Billing Code Overview
HCPCS Level II code G8476 indicates that the most recent blood pressure measurement for a patient has a systolic value less than 140 mmHg and a diastolic value less than 90 mmHg. This code documents a blood pressure reading within the specified control range.
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Service type: Vital sign measurement / blood pressure assessment
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Typical site of service: Office or outpatient clinical setting where vital signs are recorded (e.g., primary care clinic, outpatient specialty clinic)
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of well-controlled hypertension presents for a routine primary care follow-up. The nurse measures vital signs at triage using an automated or manual sphygmomanometer; the most recent office blood pressure reading is documented as 132/78 mmHg. The primary care clinician reviews the measurement during the visit, confirms technique (seated, arm supported, appropriate cuff size), and documents the most recent blood pressure as systolic < 140 mmHg and diastolic < 90 mmHg to meet blood pressure control quality measures. This assessment is used for performance reporting, chronic disease management records, and may be reported to payors and quality registries. Typical sites of service include outpatient primary care clinics, community health centers, and ambulatory care settings where blood pressure measurements are routinely obtained during office visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the service due to complexity or difficulty during the visit where BP measurement required extra work. |
23 | Unusual anesthesia |