G9797 — Patient is not on a high intensity statin therapy
G9797 is a HCPCS Level II code for patient is not on a high intensity statin therapy. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9797
- Long descriptor
- Patient is not on a high intensity statin therapy
- Short descriptor
- Pt not currently on statin
- Added
- January 1, 2017
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G9797
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9797 is not quite right, the correct code is very often within a few positions of it.
- G9789Blood pressure recorded during inpatient stays, emergency room visits, or urgent care visits
- G9790Most recent bp is greater than 130/80 mm hg, or blood pressure not documented
- G9791Most recent tobacco status is tobacco free
- G9792Most recent tobacco status is not tobacco free
- G9793Patient is currently on a daily aspirin or other antiplatelet
- G9794Documentation of medical reason(s) for not on a daily aspirin or other antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed, idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of active anticoagulant use during the measurement period)
- G9795Patient is not currently on a daily aspirin or other antiplatelet
- G9796Patient is currently on a high intensity statin therapy
- G9798Discharge(s) for ami between july 1 of the year prior measurement period to june 30 of the measurement periodterminated
- G9799Patients with a medication dispensing event indicator of a history of asthma any time during the patient's history through the end of the measure periodterminated
- G9800Patients who are identified as having an intolerance or allergy to beta-blocker therapyterminated
- G9801Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosisterminated
- G9802Patients who use hospice services any time during the measurement periodterminated
- G9803Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for amiterminated
- G9804Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for amiterminated
- G9805Patients who use hospice services any time during the measurement period
Questions about G9797
What is HCPCS code G9797?
G9797 is a HCPCS Level II code for patient is not on a high intensity statin therapy. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9797?
The CMS HCPCS file marks G9797 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G9797 paid under the physician fee schedule?
G9797 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.