Question 1

What is HCPCS code G8815?

Accepted Answer

HCPCS code G8815 is "Doc reas no statin therapy". Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)

Question 2

What category is G8815 in?

Accepted Answer

G8815 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8815?

Accepted Answer

Use G8815 when billing for doc reas no statin therapy. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G8815 covered by Medicare?

Accepted Answer

Coverage for G8815 (Doc reas no statin therapy) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G8815?

Accepted Answer

Documentation for G8815 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).