G9507 HCPCS Level II Code: G9507
Medicare Coverage & Payment
- CMS short descriptor: Doc reas on statin or contra
- Medicare coverage: Carrier judgment (CMS coverage code C)
- Payment category: Service not separately priced (pricing indicator 00)
- BETOS: Z2 — Undefined codes
- Last CMS action effective: January 1, 2016
Source: CMS HCPCS Level II release. Coverage codes indicate how Medicare treats the code, not whether a specific claim will be paid; payer policy and documentation still govern.
Code Overview
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) is a HCPCS Level II code (G9507). CMS assigns coverage code C — Carrier judgment. Short description: Doc reas on statin or contra.
MedCoder summary Summary composed by MedCoder from this code's official HCPCS Level II record. The tabular instructional notes themselves appear verbatim below.
Contextual Map
Every relationship of G9507 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.
Nearest codes (40)
- G9500 — Radiation exposure indices documented in final report for procedure using fluoroscopy[Sibling]— CMS HCPCS Level II code set
- G9501 — Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given[Sibling]— CMS HCPCS Level II code set
- G9502 — Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)[Sibling]— CMS HCPCS Level II code set
- G9503 — Patient taking tamsulosin hydrochloride[Sibling]— CMS HCPCS Level II code set
- G9504 — Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy[Sibling]— CMS HCPCS Level II code set
- G9505 — Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason[Sibling]— CMS HCPCS Level II code set
- G9506 — Biologic immune response modifier prescribed[Sibling]— CMS HCPCS Level II code set
- G9508 — Documentation that the patient is not on a statin medication[Sibling]— CMS HCPCS Level II code set
- and 32 more
Change history
- January 1, 2016 — Added to the code set [Change history]— CMS release files (code change ledger)
Sources for this page
Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.
- Code, descriptors, coverage and pricing attributes Official source data
- CMS HCPCS Alpha-Numeric (ANWEB) release — July 2026 quarterly update Release, file and checksum · Publisher’s page
- Change history and date-of-service validity Official source data
- CMS HCPCS quarterly update files, ingested into the change ledger Release, file and checksum · Publisher’s page
- Comparisons, relationships and the contextual map MedCoder structured relationship
- Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
- Summary and FAQ answers MedCoder explanation
- Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.
Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates
Change history
- January 1, 2016Added to the code setDocumentation 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)
Nearest Codes in This Family
Official HCPCS Level II classifications closest to G9507 in its code family, with their registry titles.
- G9502 — Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the…
- G9503 — Patient taking tamsulosin hydrochloride
- G9504 — Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
- G9505 — Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
- G9506 — Biologic immune response modifier prescribed
- G9508 — Documentation that the patient is not on a statin medication
- G9509 — Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
- G9510 — Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less…
- G9511 — Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
- G9512 — Individual had a pdc of 0.8 or greater