G8817 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G8817: Statin Therapy Not Prescribed at Discharge, Reason Not Given

HCPCS Level II code G8817 flags instances where a patient is discharged without a prescribed statin and no reason for omission is documented. This indicator is relevant nationally because statin therapy is a common secondary prevention strategy for cardiovascular disease, and gaps in prescription or documentation can affect quality measurement, care coordination, and medication safety across settings.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on how the code is used to capture discharge medication omissions, the service type (medication reconciliation and discharge medication management), and the typical site of service (inpatient or facility discharge). The publication outlines benchmarking considerations, implications for quality reporting and documentation, and relevant policy context affecting payers and providers.

The content that follows provides operational detail for billing and documentation, common modifiers and typical related data elements where available, and notes on what information is not present in the input. Data not available in the input will be identified explicitly in those sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8817HCPCS Level IIstatin therapydischarge medicationmedication reconciliationquality measurehospital dischargeclinical documentation

Billing Code Overview

HCPCS Level II code G8817 indicates statin therapy not prescribed at discharge, reason not given. This code documents that a patient who may have been eligible for statin therapy at the time of hospital discharge left the facility without a statin prescription and without a documented reason for omission.

Service type: Medication reconciliation and discharge medication management
Typical site of service: Inpatient hospital discharge or other facility discharge settings

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult hospitalized for acute coronary syndrome or ischemic stroke who is being prepared for discharge. During the inpatient medication reconciliation and discharge planning workflow, the treating physician or cardiology/stroke team documents discharge medications. For patients with atherosclerotic cardiovascular disease, statin therapy is guideline-directed; however, when statin therapy is not prescribed at discharge and no reason is recorded, the billing code G8817 is used to indicate that statin therapy was not prescribed and the reason was not given. The scenario often involves review of inpatient records, medication reconciliation by nursing or pharmacy, and final discharge orders placed by the attending physician. Typical sites of service include inpatient acute care hospitals, observation units, and inpatient rehabilitation facilities. Common patient characteristics include recent myocardial infarction, ischemic stroke, peripheral arterial disease, or documented atherosclerotic cardiovascular disease where statin therapy would normally be expected but is absent from discharge medications without documented rationale.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Used when work required to document or address omission of statin therapy at discharge is substantially greater than typical (rare for this code).

HCPCS G0129: Occupational Therapy in PHP/IOP, 45+ Minute Session

HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G9210-HEPATITIS-C-QUANTITATIVE-RNA-TESTING-NOT-PERFORMED-4-12-WEEKS

HCPCS G9210: Hepatitis C Quantitative RNA Test Not Performed (4-12 Weeks)

HCPCS-G9924-DOCUMENTATION-MEDICAL-REASON-FOR-OMITTING-SAFETY-SCREEN

HCPCS G9924: Documentation of Medical Reason to Omit Safety Screening

HCPCS-G9637-DOSE-REDUCTION-TECHNIQUES-REPORTING

HCPCS G9637: Final Report Documenting Imaging Dose Reduction Techniques

HCPCS-G2201-DOCUMENTATION-OF-MEDICAL-REASON-FOR-NOT-PROVIDING-BRIEF-COUNSELING

HCPCS G2201: Documentation of Medical Reason for Not Providing Brief Counseling

HCPCS-G9295-SPECIMEN-SITE-NON-CUTANEOUS

HCPCS G9295: Specimen Site Other Than Cutaneous Location

HCPCS-G0558-ADVANCED-PRIMARY-CARE-MANAGEMENT

HCPCS G0558: Advanced Primary Care Management for Complex Chronic Patients

HCPCS-G2081-INSTITUTIONAL-SNP-LONG-TERM-CARE-90-DAYS

HCPCS G2081: Institutional SNP or Long-Term Care Residence >90 Days

HCPCS-G9244-ANTIRETROVIRAL-THERAPY-NOT-PRESCRIBED

HCPCS G9244: Antiretroviral Therapy Not Prescribed

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RC0000X`	Cardiology	Cardiologists commonly evaluate and manage statin therapy for coronary disease patients.
`207RG0300X`	Interventional Cardiology	Interventionalists involved in MI admissions may document discharge medications.
`2084P0800X`	Neurology	Neurologists manage secondary prevention after ischemic stroke, including statins.
`208D00000X`	Internal Medicine	Hospitalists and internists frequently handle discharge medication reconciliation and documentation.
`261QM0800X`	Clinical Pharmacy	Clinical pharmacists often perform medication reconciliation and identify missing statin therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I21.9`	Acute myocardial infarction, unspecified	MI patients routinely require statin therapy for secondary prevention; omission at discharge is relevant.
`I63.9`	Cerebral infarction, unspecified	Ischemic stroke patients are commonly prescribed statins for secondary prevention; absence at discharge is significant.
`I70.9`	Atherosclerosis of arteries, unspecified	Atherosclerotic disease generally warrants statin therapy; lack of prescription is noteworthy.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Chronic coronary disease patients are typical candidates for statin therapy.
`E78.5`	Hyperlipidemia, unspecified	Elevated lipids is an indication for statin therapy; omission at discharge may reflect oversight.
`Z98.890`	Other specified postprocedural states	Patients post-revascularization or other procedures often require medication management including statins.
`Z79.899`	Other long term (current) drug therapy	Documentation related to chronic medication use; absence of statin on discharge med list is relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes at bedside	Often used for the admitting physician evaluation during which discharge planning and medication decisions, including statin prescribing, begin.
`99238`	Hospital discharge day management; 30 minutes or more	Used for the final discharge encounter when medications are reconciled and prescriptions should be issued.
`99495`	Transitional care management, moderate complexity (communication within 2 business days)	May be billed for post-discharge follow-up addressing medication changes including initiation of statin therapy.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Frequently performed during discharge counseling for cardiovascular risk reduction alongside statin discussion.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; interpretation and report	Common diagnostic performed during the admission for cardiac indications that prompt statin consideration.

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