HCPCS G9788: Blood Pressure ≤ 130/80 mm Hg - OpenPayer

Summary & Overview

HCPCS G9788: Blood Pressure ≤ 130/80 mm Hg

HCPCS Level II code G9788 documents that a patient’s most recent blood pressure is less than or equal to 130/80 mm Hg. As a quality and clinical-status measure, this code captures blood pressure control for patients receiving outpatient or ambulatory care and is relevant to chronic disease management programs, population health reporting, and quality measurement nationally.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, the typical clinical settings where the code is applied, and the types of benchmarks and policy interpretations commonly associated with blood pressure control indicators. The publication outlines how G9788 is used in claims to denote controlled blood pressure at the specified threshold and highlights implications for quality reporting, care coordination, and chronic disease management programs.

This summary provides national context for clinicians, billing professionals, and policy analysts seeking a clear, code-focused reference. Data not available in the input will be noted where applicable in detailed sections of the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9788HCPCS Level IIblood pressurehypertension controloutpatientquality measurechronic disease managementambulatory care

Billing Code Overview

HCPCS Level II code G9788 indicates that the most recent blood pressure is less than or equal to 130/80 mm Hg. This code documents blood pressure control status for a patient, reflecting a blood pressure measurement at or below the stated threshold.

Service type: Blood pressure measurement and control assessment
Typical site of service: Outpatient clinic visits, primary care settings, chronic care management encounters, or other ambulatory care settings where blood pressure is measured and recorded.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A primary care patient with hypertension attends a routine follow-up visit. The clinician obtains an office blood pressure measurement using an automated cuff per clinic protocol. The most recent BP recorded in the chart is <= 130/80 mm Hg, qualifying for documentation under billing code G9788. Typical workflow: patient check-in and vitals by medical assistant, clinician review of current medications and adherence, focused cardiovascular exam, verification of BP reading and last recorded value in the electronic health record, and documentation of the controlled BP value. Typical site of service: outpatient primary care clinic, community health center, or telehealth visit with validated home BP reporting. Typical patient scenario: a middle-aged adult with known hypertension on antihypertensive therapy presenting for follow-up whose most recent clinic measurement and/or validated home reading is <= 130/80 mm Hg, medication regimen reviewed, and BP control documented in the medical record. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G8771: Documentation of Chronic Kidney Disease

HCPCS-G9681-ONSITE-ACUTE-COPD-ASTHMA-TREATMENT

HCPCS G9681: Onsite Acute Treatment for COPD or Asthma

HCPCS-G0036-PATIENT-CARE-PARTNER-DECLINE-ASSESSMENT

HCPCS G0036: Patient or Care Partner Decline Assessment

HCPCS-G8465-PROSTATE-CANCER-HIGH-VERY-HIGH-RECURRENCE-RISK

HCPCS G8465: High or Very High Risk of Prostate Cancer Recurrence

HCPCS-G9912-HBV-ASSESSMENT-BEFORE-ANTI-TNF-THERAPY

HCPCS G9912: Hepatitis B Assessment and Interpretation Before Anti-TNF Therapy

HCPCS-G2058-CHRONIC-CARE-MANAGEMENT-ADDITIONAL-20-MIN

HCPCS G2058: Chronic Care Management, Additional 20 Minutes

HCPCS-G0130-PERIPHERAL-BONE-DENSITY-SEXA

HCPCS G0130: Peripheral Bone Density Study (Single-Energy X-Ray Absorptiometry)

HCPCS-G9735-SHOULDER-PROM-UNABLE-TO-COMPLETE-DUE-TO-COMMUNICATION-BARRIERS

HCPCS G9735: Shoulder PROM Unable to Complete Due to Communication or Capacity Barriers

HCPCS-G0914-PATIENT-SURVEY-NOT-COMPLETED

HCPCS G0914: Patient Care Survey Not Completed by Patient

HCPCS-G8664-SHOULDER-IMPAIRMENT-RESIDUAL-SCORE-NEGATIVE

HCPCS G8664: Shoulder Residual Impairment Score < 0

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Internal Medicine	Primary specialty managing hypertension and documenting BP control.
`207R00000X`	Family Medicine	Common site for longitudinal BP management and documentation.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians who frequently manage hypertension and document BP readings.
`2084P0800X`	Cardiovascular Disease	Cardiology involvement for complex or resistant hypertension follow-up.
`207V00000X`	Geriatric Medicine	Management of BP control in older adults with attention to comorbidities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I10`	Essential (primary) hypertension	Primary diagnosis for patients monitored for BP control; direct relevance to `G9788`.
`I11.9`	Hypertensive heart disease without heart failure	Hypertension with cardiac involvement; BP control is critical for management.
`I12.9`	Hypertensive chronic kidney disease without stage specification	Hypertension contributes to CKD; documenting controlled BP is important for renal protection.
`I15.9`	Secondary hypertension, unspecified	Secondary causes of hypertension where BP control status remains relevant.
`E78.5`	Hyperlipidemia, unspecified	Common comorbidity in patients with hypertension; risk factor management often occurs concurrently.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes is a common comorbidity requiring BP targets to reduce cardiovascular risk.
`Z79.899`	Other long term (current) drug therapy	Indicates chronic medication use, often antihypertensive therapy relevant to BP control.
`Z71.89`	Other specified counseling	Counseling related to lifestyle modification that supports BP control.

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 for routine hypertension follow-up during which BP is measured and `G9788` status is documented.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, 3-10 minutes	Often provided alongside hypertension management as counseling that may influence BP control.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar month	May be billed for ongoing hypertension care coordination when meeting requirements; BP control documentation supports chronic disease management.
`93784`	Ambulatory blood pressure monitoring, utilizing a device worn by the patient for 24 hours (Note: this CPT is commonly used for ambulatory BP monitoring)	Performed when white coat or masked hypertension is suspected; complements clinic BP readings used for control assessment.
`99457`	Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician time in a calendar month	Used when hypertension is managed via remote BP monitoring; validated home readings that are `<= 130/80 mm Hg` can be part of RPM reporting.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver, requiring 30 minutes of time	Applicable when clinicians review and interpret home BP data contributing to documented controlled BP status.

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