Summary & Overview
HCPCS G8551: Heart Failure Quality Measures Completed
HCPCS Level II code G8551 documents that all applicable quality actions within the heart failure measures group have been completed for a patient. Nationally, this code is used to capture adherence to heart failure performance measures, supporting quality reporting, population health management, and payer performance programs. The code informs whether required clinical processes — such as medication reconciliation, patient education, follow-up planning, and device or therapy tracking where applicable — were addressed according to the measure specifications.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical intent and service context, comparative coverage considerations across major payers, typical settings where the code is reported, and the types of benchmarks and policy updates that affect its use. The publication also outlines what is commonly included in heart failure measure completion and how G8551 functions within quality reporting programs. Data not available in the input are noted where relevant.
Billing Code Overview
HCPCS Level II code G8551 indicates that all quality actions for the applicable measures in the heart failure (hf) measures group have been performed for this patient. This denotes completion of the set of heart failure quality measures applicable to the patient's care episode.
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Service type: Quality reporting / performance measurement documentation
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Typical site of service: Outpatient clinic, hospital outpatient department, or other ambulatory care settings where heart failure quality measures are assessed and documented
Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 72-year-old man with chronic heart failure with reduced ejection fraction who presents for a follow-up visit in a cardiology clinic or primary care office. During the visit the clinician documents assessment of volume status, review of current medications (including ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist), evaluation of recent weight and symptom changes, assessment of device status if applicable (eg, ICD/CRT), medication reconciliation, counseling on sodium and fluid restriction, vaccination status, and orders for appropriate labs (BMP, BNP) and imaging (echocardiogram) when indicated. The clinical team completes all required quality actions for measures in the heart failure measures group, including documentation of left ventricular ejection fraction, provision of guideline-directed medical therapy or documented contraindications, patient education, and follow-up planning. The service is billed using G8551, typically reported by outpatient clinics, cardiology practices, or primary care offices as part of quality reporting programs. Typical sites of service include outpatient hospital clinics, physician offices, and community health centers where chronic disease management and quality measure documentation occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service |