| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
G9507 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
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) |
| HCPCS Short Description |
Doc reas on statin or contra |
| HCPCS Pricing Indicator Code 1 |
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 Code |
C - Carrier judgment |
| HCPCS Berenson-Eggers Type Of Service Code |
Z2 - Undefined codes |
| HCPCS Type Of Service Code 1 |
1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96 |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2016 |
| HCPCS Action Effective Date |
1/1/2016 |
| HCPCS Action Code |
N - No maintenance for this code |