G9665 HCPCS Reimbursement & Policy

HCPCS Level II code G9665 identifies patients who are not current users of statin therapy or who did not receive an order for statin therapy during a clinical encounter. The code captures the absence of statin prescribing and is relevant for quality measurement, clinical documentation, and population-level tracking of preventive cardiovascular care. Nationally, documenting patients not on statins can inform programmatic efforts to measure gaps in preventive pharmacotherapy and support risk stratification for cardiovascular prevention.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning and service context, typical sites of service, and the payer mix relevant to national reporting. The publication also outlines common analytic uses such as benchmarking and quality measurement, notes the availability of supporting metadata, and flags where input data is not provided.

This summary is intended for clinicians, billing professionals, and policymakers seeking clear, national-level context for G9665, including how the code is applied in outpatient and ambulatory settings and what documentation this code represents for statin non-use.

Billing Code Overview

HCPCS Level II code G9665 denotes patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy. This code is used to identify and report clinical encounters in which statin therapy was not initiated or prescribed for eligible patients.

Service type: Medication management / preventive pharmacotherapy assessment
Typical site of service: Outpatient clinic, primary care office, or ambulatory care setting

Clinical Context

A typical patient is an adult with established atherosclerotic cardiovascular disease (ASCVD) risk factors who is seen in primary care or cardiology clinic during a medication-review visit. The patient is not currently taking statin therapy and no new statin prescription or order is placed during the encounter, which triggers billing with code G9665. The clinical workflow includes: initial intake and medication reconciliation, review of lipid panel and cardiovascular risk, discussion of benefits and risks of statin therapy, documentation of the reason for no statin initiation (patient refusal, prior intolerance, contraindication, or clinician decision), patient education provided, and follow-up planning. Typical sites of service are outpatient clinic, cardiology office, family medicine practice, community health centers, and telehealth visits when allowed by payor policy. Common scenarios include: a patient who previously discontinued statin due to adverse effects and declines rechallenge; a patient with possible drug interaction where prescriber defers statin initiation; or a low-risk patient where the clinician elects lifestyle management without prescribing a statin at that visit.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater work, complexity, or time for the visit beyond typical management of statin therapy discussion.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common specialty managing primary prevention and medication reconciliation.
`207RC0000X`	Internal Medicine	Primary care internists frequently manage lipid therapy decisions.
`207RP1001X`	Cardiology	Cardiology consults for high-risk ASCVD patients where statin initiation is considered.
`363A00000X`	Nurse Practitioner	NPs often perform medication review and counseling in outpatient settings.
`367500000X`	Physician Assistant	PAs commonly conduct medication management visits and document reasons for non-initiation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E78.5`	Hyperlipidemia, unspecified	Primary diagnosis associated with consideration of statin therapy; often the reason for discussing but not initiating statin treatment.
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	ASCVD diagnosis where statin therapy is typically indicated; code used when patient has established disease but is not currently on statin.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes increases ASCVD risk and is a common comorbidity prompting statin consideration.
`I10`	Essential (primary) hypertension	Hypertension frequently coexists with lipid disorders and factors into overall cardiovascular risk assessment.
`Z79.82`	Long term (current) use of aspirin	Relevant medication history code; documents cardiovascular preventive therapy when statin is not started.
`Z91.018`	Allergy to penicillin [if applicable]	Example of intolerance/allergy coding pattern; for statin intolerance the specific code `Z88.0` (allergy to penicillin) is an analogy—document the appropriate statin intolerance or adverse effect code as applicable.
`R68.89`	Other general symptoms and signs	May be used to document symptoms reported as reasons for statin intolerance or non-initiation such as myalgias.
`Z71.89`	Other specified counseling	Used when counseling explains decision to defer statin therapy (lifestyle counseling, risk discussion).

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 E/M code used when counseling about statin therapy occurs without initiation; documents moderate complexity decision-making.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when counseling and documentation of reasons for not prescribing a statin involve moderate to high complexity and extended time.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Often provided alongside statin discussion as part of cardiovascular risk reduction counseling.
`80061`	Lipid panel (total cholesterol, HDL, and triglycerides)	Laboratory test frequently ordered or reviewed during visits where statin therapy is considered; may be performed before future initiation.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by physician or other qualified health professional per calendar month	May be billed when statin management (including decision not to start) is part of ongoing chronic disease management for conditions like hyperlipidemia or diabetes.

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Summary & Overview

HCPCS G9665: Patients Not on Statin Therapy