G9277 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9277: Documentation of Daily Aspirin or Anti-Platelet Use or Exception

HCPCS Level II code G9277 captures documentation that a patient is taking daily aspirin or another anti-platelet agent, or that a clinician has recorded a valid contraindication or exception to such therapy. This code matters nationally because it supports quality measurement and clinical decision-making around secondary prevention of cardiovascular events, bleeding risk management, and medication safety. Clear documentation affects care continuity, quality reporting, and payer review.

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 G9277 represents, typical service settings, and the clinical scenarios that meet documentation criteria. The publication outlines common clinical exceptions (for example, anticoagulant use, allergy, prior gastrointestinal bleed, bleeding disorders, uncontrolled hypertension, NSAID use, drug interaction risk, and gastroesophageal reflux) that clinicians may document when daily aspirin or anti-platelet therapy is not used.

This piece also summarizes what to expect in payer coverage and coding practice at a national level, highlights where documentation supports quality measures, and identifies areas where data were not provided in the input (such as associated taxonomies, ICD-10 pairings, and related codes).

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9277HCPCS Level IIaspirin documentationanti-platelet therapymedication reconciliationquality reportingoutpatient servicesbleeding risk

Billing Code Overview

HCPCS Level II code G9277 documents that a patient is on daily aspirin or an anti-platelet agent, or that there is documentation of a valid contraindication or physician-documented exception to daily aspirin/anti-platelet therapy. Contraindications and exceptions listed include use of anticoagulants, allergy to aspirin or anti-platelets, history of gastrointestinal bleed, and bleeding disorders; additional acceptable physician-documented exceptions include use of non-steroidal anti-inflammatory agents, documented risk for drug interaction, uncontrolled hypertension (systolic >180 or diastolic >110), or gastroesophageal reflux.

Service Type: Medication reconciliation / preventive medication documentation

Typical Site of Service: Outpatient clinic, primary care or specialty office visits, and community or ambulatory care settings

Clinical & Coding Specifications

Clinical Context

A typical outpatient cardiology or primary care clinic visit for secondary prevention following an ischemic stroke, transient ischemic attack, or established coronary artery disease. A 68-year-old patient with prior myocardial infarction presents for routine follow-up. The clinician reviews current medications and documents that the patient is taking daily low-dose aspirin 81 mg. If the patient is not on aspirin or another antiplatelet agent, the clinician documents a valid contraindication or acceptable exception such as concurrent oral anticoagulant therapy, documented allergy to aspirin or antiplatelets, history of gastrointestinal bleed, bleeding disorder, use of nonsteroidal anti-inflammatory drugs with risk for interaction, uncontrolled hypertension (systolic >180 or diastolic >110 mm Hg), or gastroesophageal reflux. The documentation is recorded in the medical record during the encounter and included in the visit note to support billing of G9277. Typical workflow steps: medication reconciliation, focused history of bleeding risk and allergies, review of blood pressure readings, reconciliation of anticoagulant use, clinician assessment and documentation of reason for not prescribing or continuing aspirin/antiplatelet, and placement of that statement in the encounter note or medication list.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when documentation supports substantially greater work or complexity related to the encounter documentation that justifies additional payment (rarely applicable for this code).

HCPCS G9055: Oncology Visit, Other Unspecified Service

HCPCS-G9776-ANTI-EMETIC-PROPHYLAXIS-MEDICAL-EXCEPTION

HCPCS G9776: Documentation of Medical Reason for Omitted Anti-Emetic Prophylaxis

HCPCS-G8882-SENTINEL-LYMPH-NODE-BIOPSY-NOT-PERFORMED

HCPCS G8882: Sentinel Lymph Node Biopsy Not Performed, Reason Not Given

HCPCS-G0442-ANNUAL-ALCOHOL-MISUSE-SCREENING-5-15-MINUTES

HCPCS G0442: Annual Alcohol Misuse Screening, 5–15 Minutes

HCPCS-G9430-SPECIMEN-NON-CUTANEOUS-SITE

HCPCS G9430: Specimen Site Other Than Cutaneous Location

HCPCS-G8569-PROLONGED-POSTOPERATIVE-INTUBATION-OVER-24-HOURS

HCPCS G8569: Prolonged Postoperative Intubation (>24 hours)

HCPCS-G9707-HOSPICE-SERVICES-MEASUREMENT-PERIOD

HCPCS G9707: Patient Received Hospice Services During Measurement Period

HCPCS-G8966-CARDIAC-STRESS-IMAGING-SYMPTOMATIC-OR-HIGH-RISK

HCPCS G8966: Cardiac Stress Imaging for Symptomatic or Higher-Risk Patients

HCPCS-G9770-PERIPHERAL-NERVE-BLOCK-PNB

HCPCS G9770: Peripheral Nerve Block (PNB)

HCPCS-G2192-TEMPORAL-HEADACHE-HEAD-IMAGING-OVER-55

HCPCS G2192: Head Imaging for Temporal Headaches in Patients Over 55

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RC0000X`	Cardiovascular Disease (Cardiology)	Cardiology clinicians commonly document antiplatelet therapy and contraindications for secondary prevention.
`207Q00000X`	Family Medicine	Primary care clinicians perform medication reconciliation and document aspirin use or exceptions during routine visits.
`207L00000X`	Internal Medicine	Internists manage chronic cardiovascular risk and document antiplatelet status.
`2084P0800X`	Physician Assistant	PAs frequently document medication lists and contraindications under supervising physicians.
`363A00000X`	Nurse Practitioner	NPs commonly record aspirin/antiplatelet use and contraindications in ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Indicates coronary artery disease where antiplatelet therapy is commonly considered for secondary prevention; documentation of aspirin use or contraindication is relevant.
`I63.9`	Cerebral infarction, unspecified	Ischemic stroke diagnosis where daily aspirin or antiplatelet therapy is commonly indicated for secondary prevention; clinician documents use or valid contraindication.
`G45.9`	Transient cerebral ischemic attack, unspecified, without residual deficits	TIA diagnosis prompting antiplatelet therapy consideration; documentation of aspirin status or exception is required.
`I21.9`	Acute myocardial infarction, unspecified	Recent MI where antiplatelet therapy is part of standard care; documentation of therapy or contraindication is pertinent.
`Z79.01`	Long term (current) use of anticoagulants	Active anticoagulant therapy is a listed contraindication/exception to daily aspirin or antiplatelet and must be documented.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common outpatient visit code during which a clinician documents daily aspirin or valid contraindication supporting `G9277` billing.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used for more complex visits where medication reconciliation and risk assessment for antiplatelet therapy require additional time and documentation.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Often performed in the same preventive care visit addressing cardiovascular risk factors alongside antiplatelet documentation.
`G0439`	Annual wellness visit, subsequent visit	Preventive or chronic care follow-up where aspirin/antiplatelet status may be documented for Medicare beneficiaries.
`36415`	Collection of venous blood by venipuncture	Laboratory testing (e.g., CBC, coagulation studies) ordered to evaluate bleeding risk or monitor anticoagulation when documenting contraindications.

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