Question 1

What is HCPCS code G9940?

Accepted Answer

HCPCS code G9940 is "Doc reas no statin therapy". Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)

Question 2

What category is G9940 in?

Accepted Answer

G9940 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9940?

Accepted Answer

Use G9940 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 G9940 covered by Medicare?

Accepted Answer

Coverage for G9940 (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 G9940?

Accepted Answer

Documentation for G9940 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).