2025 HCPCS code G9797
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Professional Services - Performance Measurement Additional Assorted Quality Measures Feed
Indicates that a patient is not currently taking statin therapy.
Modifiers are not applicable.
Medical necessity is not directly applicable to this code.The code reflects the documentation of the patient's medication status as part of quality measure reporting requirements.
The clinical responsibility is documentation of the patient's medication status.The provider documents the absence of statin therapy in the patient's record.
In simple words: This code means the patient isn't taking cholesterol-lowering medication called statins.
This HCPCS code, G9797, signifies that the patient is not receiving statin medication.Statins are a class of drugs used to lower cholesterol levels in the blood. This code is primarily used for performance measurement and quality reporting, not for direct reimbursement of services.
Example 1: A patient presents for a routine check-up. During the visit, the physician reviews the patient's medication list and notes the absence of statins. Code G9797 is used to report this finding for quality measure reporting purposes., A patient with a family history of heart disease undergoes a lipid panel. The results indicate elevated cholesterol. The physician initiates a conversation about statin therapy, but the patient chooses not to start treatment at this time. Code G9797 would be used to document this decision for performance measure reporting., A patient is participating in a clinical trial where statin therapy is contraindicated.The clinician documents that the patient is not on a statin therapy for reporting purposes.Code G9797 can be reported.
* Complete and accurate patient medical record noting the absence of statin therapy.* Documentation should clearly specify the date the medication review was conducted.* If applicable, document the reason for not initiating statin therapy (patient refusal, contraindication, etc.).
** This code is used for quality reporting purposes and should be reported in accordance with CMS guidelines for the relevant quality measure.It is important to understand that this is not a billable code in itself; rather, it's a measure of the absence of a medication.
- Revenue Code: Revenue codes will vary depending on the payer and the specific services associated with the patient's encounter.This code itself does not directly correspond to a specific revenue code.
- RVU: RVUs are not applicable to this HCPCS code, as it is a tracking code for performance measurement, not a procedure or service with a direct monetary value.
- Global Days : Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule : Not applicable. This is not a billable procedure code.
- Specialties:Cardiology, Family Medicine, Internal Medicine
- Place of Service:Office, Clinic, Hospital