G8897 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G8897: Oral Antithrombotic Not Prescribed, Reason Not Given

HCPCS Level II code G8897 documents that an oral aspirin or other antithrombotic therapy was not prescribed and no reason for the omission was recorded. Nationally, this code is used in ambulatory care and outpatient follow-up settings where secondary prevention after cardiovascular events or risk assessment requires documentation of antithrombotic prescribing. Proper use of G8897 matters for quality measurement, care coordination, and tracking gaps in guideline-directed therapy.

Key payers included in benchmarking and policy discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, common settings where it is reported, and how it fits into quality reporting frameworks. The publication summarizes available national benchmarks where present, highlights policy and claims-processing considerations relevant to major payers, and outlines the documentation practices associated with this code. Where specific payer policies or datasets are not provided, the text notes that data are not available in the input. The focus is on informing billing, coding, and compliance teams, as well as clinicians and administrators who manage medication reconciliation and secondary prevention workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8897HCPCS Level IIantithrombotic therapyaspirinmedication reconciliationquality measurementambulatory caresecondary prevention

Billing Code Overview

HCPCS Level II code G8897 indicates that oral aspirin or other antithrombotic therapy was not prescribed, reason not given. This code documents the absence of a prescribed oral antithrombotic at the time of the encounter when no specific reason for omission is recorded.

Service type: Medication reconciliation / secondary prevention medication assessment
Typical site of service: Outpatient clinic, primary care, cardiology follow-up, or other ambulatory care settings where medication prescribing and reconciliation occur.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who presents to the emergency department or an outpatient cardiology or primary care clinic after an acute ischemic stroke or transient ischemic attack (TIA), or following hospital discharge after acute coronary syndrome or percutaneous coronary intervention. During medication reconciliation and secondary prevention planning, clinicians document antithrombotic therapy decisions. In this scenario, the clinician determined that oral aspirin or another antithrombotic agent was not prescribed but did not record the reason. The workflow includes initial evaluation, assessment of bleeding risk and contraindications, review of current medications, discussion with the patient or family, and documentation in the problem list and discharge or clinic note. The omission of the reason for not prescribing an antithrombotic is captured using billing code G8897 for quality reporting and administrative tracking.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure	Use when an E/M visit unrelated to the reason for `G8897` is provided the same day.

HCPCS G8810: Rh‑immunoglobulin Not Ordered, Clinician-Documented Reasons

HCPCS-G4025-PHYSICAL-MEDICINE-MIPS-SPECIALTY-SET

HCPCS G4025: Physical Medicine MIPS Specialty Set

HCPCS-G8990-THERAPY-PRIMARY-FUNCTIONAL-LIMITATION-STATUS

HCPCS G8990: Other Therapy Primary Functional Limitation, Current Status

HCPCS-G9674-CLINICAL-ASCVD-PATIENTS

HCPCS G9674: Patients with Clinical ASCVD Diagnosis

HCPCS-G9831-AJCC-STAGE-II-III-BREAST-CANCER-DIAGNOSIS

HCPCS G9831: AJCC Stage II or III at Breast Cancer Diagnosis

HCPCS-G9380-END-OF-LIFE-ASSISTANCE-OR-PLAN-REVIEW

HCPCS G9380: End-of-Life Assistance or Plan Review

HCPCS-G0508-TELEHEALTH-CRITICAL-CARE-CONSULTATION-INITIAL

HCPCS G0508: Telehealth Critical Care Consultation, Initial

HCPCS-G8898-COPD-MEASURES-GROUP-REPORTING

HCPCS G8898: Intent to Report COPD Measures Group

HCPCS-G9784-PATHOLOGY-DERMATOPATHOLOGY-SECOND-OPINION-BIOPSY

HCPCS G9784: Pathologist/Dermatopathologist Second Opinion on Biopsy

HCPCS-G0316-PROLONGED-HOSPITAL-INPATIENT-OBSERVATION-E-M

HCPCS G0316: Prolonged Hospital Inpatient or Observation E/M, Per 15 Minutes

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RC0000X`	Cardiology	Cardiology frequently manages antithrombotic prescribing after ACS, PCI, or stroke.
`207Q00000X`	Interventional Cardiology	Interventional cardiologists document peri-procedural antithrombotic plans.
`208D00000X`	Neurology	Neurologists manage antithrombotic decisions after ischemic stroke or TIA.
`207L00000X`	Internal Medicine	Hospitalists and primary care physicians reconcile medications and document reasons for non-prescription.
`363L00000X`	Nurse Practitioner	Advanced practice providers often document medication decisions and rationale.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I63.9`	Cerebral infarction, unspecified	Ischemic stroke where antithrombotic therapy is typically indicated for secondary prevention.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIA commonly necessitates assessment for antiplatelet or anticoagulant therapy.
`I21.9`	Acute myocardial infarction, unspecified	Acute coronary syndrome where antithrombotic therapy is standard unless contraindicated.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Chronic coronary disease where aspirin is often prescribed for secondary prevention.
`I48.91`	Unspecified atrial fibrillation and flutter	Atrial fibrillation frequently prompts anticoagulation decisions to reduce stroke risk.
`D68.4`	Acquired coagulation factor deficiency	Bleeding risk condition that may contraindicate antithrombotic therapy and require documentation of rationale.
`K92.2`	Gastrointestinal hemorrhage, unspecified	Active or recent GI bleed is a common contraindication needing clear documentation when withholding antithrombotics.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99221`	Initial hospital care, typically 30 minutes at bedside and on the patient; for inpatient admission	Used when admitting a patient where antithrombotic prescribing decisions are made and documented.
`99232`	Subsequent hospital care, typically 25 minutes; for evaluation and management during inpatient stay	Used for follow-up inpatient evaluations addressing antithrombotic therapy decisions.
`99214`	Office or other outpatient visit for established patient, typically 25 minutes	Used in clinic visits where medication reconciliation and documentation regarding antithrombotic prescribing occur.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3-10 minutes	Often provided alongside secondary prevention counseling but billed separately from medication documentation.
`93792`	Physician outpatient visit for evaluation/management of patients with cardiovascular device or durable monitoring (remote monitoring)	Used when remote monitoring or device follow-up influences antithrombotic therapy decisions.

OpenPayer