Summary & Overview
HCPCS G8595: Most Recent LDL-C < 100 mg/dl
HCPCS Level II code G8595 identifies patients whose most recent low-density lipoprotein cholesterol (LDL-C) is below 100 mg/dl. As a quality reporting code tied to lipid management, it is used across outpatient and ambulatory settings to document cardiovascular risk control and support quality measurement programs nationally. The code matters because LDL-C control is a core metric in preventive cardiology and chronic disease management, influencing population health programs and payer quality initiatives.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the clinical context for LDL-C measurement, and the typical settings where the code is applied. The publication outlines common benchmarks for LDL-C control, considerations for billing as a lab/result quality measure, and relevant policy and reporting implications for payers and health systems.
This summary is intended for clinicians, billing and compliance staff, and health plan analysts seeking a clear national-level description of HCPCS Level II code G8595, its clinical relevance, and where it is used in practice.
Billing Code Overview
HCPCS Level II code G8595 denotes Most recent LDL-C < 100 mg/dl. This code represents a clinical quality measure capturing the most recent low-density lipoprotein cholesterol (LDL-C) value below 100 mg/dl for an eligible patient.
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Service type: Laboratory result reporting/quality measure tracking
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Typical site of service: Outpatient clinic or ambulatory laboratory where lipid testing is performed
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old man with a history of hyperlipidemia and coronary artery disease who presents to a primary care clinic for a chronic disease follow-up. The clinician reviews the patient’s most recent fasting lipid panel performed within the measurement period and documents an LDL-C result of 92 mg/dL. The workflow includes: ordering or verifying a recent lipid panel (if not already available), reviewing results in the electronic health record, reconciling current lipid-lowering therapy, documenting the most recent LDL-C value and date in the chart, and coding the encounter for quality measurement purposes using the HCPCS Level II code G8595 to indicate the patient’s most recent LDL-C is less than 100 mg/dL. Typical communication may include counseling on adherence and risk reduction, and the result is used for performance reporting and care management registries.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when an E/M visit is distinct from the encounter for ordering or reviewing the LDL-C lab and the visit meets E/M documentation requirements. |
26 | Professional component | Use when reporting only the professional interpretation component of a lab or service, if applicable in mixed billing arrangements.