2024 HCPCS Code G9507
Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
TAGS: interaction intolerance patient provider birth disease woman toxic myostitis trying pregnancy exception documented codes heart taking statin liver documentation defined least years include stage contraindication diagnosis active actively protease medication myopathy supporting during within renal dialysis measurement valid allergy
| Short Description | Doc reas on statin or contra |
| HCPCS Coverage Code | C - Carrier judgment |
| HCPCS Action Code | N - No maintenance for this code |
| HCPCS Action Effective Date | January 01, 2016 |
| HCPCS Code Added Date | January 01, 2016 |
| HCPCS Pricing Indicator Code | 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.) |
| HCPCS Multiple Pricing Indicator Code | 9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99') |
| HCPCS Coverage Issues Manual Reference Section Number | |
| HCPCS Type Of Service Code | 1 - Medical care |
| HCPCS Anesthesia Base Unit Quantity | 0 |
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