G9508 (HCPCS) Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9508: Documentation of Not Being on a Statin Medication

HCPCS Level II code G9508 documents that a patient is not taking a statin medication. Nationally, clear documentation of statin nonuse matters for care coordination, risk stratification, quality measurement, and accurate clinical records. The code supports encounters where clinicians note absence of statin therapy as part of medication reconciliation, cardiovascular risk assessment, or preventive care.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning, typical sites of service, and common administrative considerations. The publication outlines benchmarks and policy-relevant context for coding practices, highlights where this documentation is used in quality measurement, and summarizes implications for billing and clinical workflows.

The analysis focuses on national applicability rather than state-level rules. It provides practical guidance on when this code is likely recorded, how it fits into routine ambulatory visits, and what audiences—coding professionals, clinicians, and compliance officers—should note when reviewing documentation and claims. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9508HCPCS Level IImedication reconciliationstatin therapycardiovascular riskambulatory carequality measurementclinical documentation

Billing Code Overview

HCPCS Level II code G9508 documents that the patient is not on a statin medication. This code is used to record clinician documentation of the absence of statin therapy for a patient, typically in the context of medication reconciliation, cardiovascular risk assessment, or preventive care workflows.

Service Type: Medication status documentation / Clinical assessment

Typical Site of Service: Outpatient clinic, primary care office, cardiology clinic, or other ambulatory care settings

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult outpatient visit to primary care or cardiology for cardiovascular risk assessment or medication reconciliation. The clinician documents that the patient is not currently taking a statin medication after reviewing medication lists, pharmacy records, or direct patient report. Typical workflow: patient arrives for an annual preventive visit or follow-up for hyperlipidemia or coronary artery disease; medical assistant reconciles medications; clinician reviews indications for statin therapy and documents decision-making; a discrete statement is recorded in the medical record that the patient is not on a statin and the reason if applicable (e.g., no indication, patient refusal, intolerance, or contraindication). The service is billed using G9508 to indicate documentation that the patient is not on a statin. Typical site of service is an outpatient clinic (primary care, cardiology, or preventive medicine). Common clinical scenarios include: patient with no history of atherosclerotic cardiovascular disease and no indication for statin; patient with prior statin intolerance or adverse effect documented; patient declines statin therapy after counseling.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When substantially greater physician work is documented beyond typical counseling or documentation related to statin non-use.

Related Codes

HCPCS-G8798-NONPROSTATE-SPECIMEN-SITE

HCPCS G8798: Specimen Site Other Than Anatomic Location of Prostate

HCPCS-G9651-PSORIASIS-ASSESSMENT-DOCUMENTATION-NOT-MEETING-BENCHMARKS

HCPCS G9651: Psoriasis Assessment Tool Not Documented or Not Meeting Benchmarks

HCPCS-G9583-PROLONGED-OPIOID-THERAPY-GREATER-THAN-SIX-WEEKS

HCPCS G9583: Patients Prescribed Opiates for Longer Than Six Weeks

HCPCS-G8559-OTOLOGIC-EVALUATION-REFERRAL

HCPCS G8559: Referral for Otologic Evaluation

HCPCS-G9794-NO-DAILY-ASPIRIN-ANTIPLATELET-DOCUMENTATION

HCPCS G9794: Documentation of Reason for Not Prescribing Daily Aspirin/Antiplatelet

HCPCS-G9958-MISSED-COMBINATION-PROPHYLACTIC-ANTIEMETIC-THERAPY

HCPCS G9958: Missed Combination Prophylactic Antiemetic Therapy

HCPCS-G9835-TRASTUZUMAB-WITHIN-12-MONTHS-OF-DIAGNOSIS

HCPCS G9835: Trastuzumab Administered Within 12 Months of Diagnosis

HCPCS-G9268-COMPLICATION-DOCUMENTATION-WITHIN-90-DAYS

HCPCS G9268: Documentation of Complications Within 90 Days

HCPCS-G9376-RETINA-ATTACHED-6-MONTHS-AFTER-SINGLE-SURGERY

HCPCS G9376: Retina Attached at 6-Month Follow-Up After One Surgery

HCPCS-G1008-CLINICAL-DECISION-SUPPORT-CRANBERRY-PEAK

HCPCS G1008: Clinical Decision Support Mechanism, Cranberry Peak

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly document statin use or non-use during preventive and chronic care visits.
`207R00000X`	Internal Medicine	Internists perform cardiovascular risk assessment and medication reconciliation including statin documentation.
`207RH0000X`	Cardiology	Cardiologists document statin use status for patients with known coronary artery disease or high cardiovascular risk.
`366A00000X`	Nurse Practitioner	Nurse practitioners frequently reconcile medications and document statin non-use in outpatient settings.
`363L00000X`	Physician Assistant	Physician assistants perform medication reconciliation and document statin status under supervising physician protocols.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E78.0`	Pure hypercholesterolemia	Common indication for considering statin therapy; documentation of non-use is relevant to treatment planning.
`E78.5`	Hyperlipidemia, unspecified	Broad lipid disorder category where clinician documents whether statin therapy is being used.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Secondary prevention patients in this category are generally indicated for statin therapy; documentation of non-use is critical.
`I63.9`	Cerebral infarction, unspecified	History of ischemic stroke can indicate statin therapy for secondary prevention; noting non-use is clinically relevant.
`I21.9`	Acute myocardial infarction, unspecified	Post-MI patients are typically indicated for statin therapy; documentation when not on a statin is important for care coordination.
`Z79.82`	Long term (current) use of aspirin	Often documented alongside statin status when managing cardiovascular preventive therapies.
`Z79.899`	Other long term (current) drug therapy	Documents ongoing preventive therapies; absence of statin may be noted in the medication list.
`Z71.89`	Other specified counseling	Counseling encounters addressing cardiovascular risk where statin non-use is 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, low to moderate complexity	Common E/M code for an outpatient visit during which statin non-use is documented as part of medication reconciliation and management.
`99495`	Transitional care management services with moderate medical decision making and communication within 14 days, interactive contact within 2 business days	May be billed when medication reconciliation including statin documentation is performed as part of transitional care after discharge.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Often performed in the same visit addressing cardiovascular risk factors; documentation of statin non-use may accompany counseling.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Medication reconciliation and documentation of non-use of statin may be part of monthly chronic care management activities.
`96160`	Administration of patient-focused health risk assessment instrument (e.g., health risk appraisal) and documentation, per screening	Risk assessment activities that include medication review may accompany documentation that the patient is not on a statin.