G9667 – Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
HCPCS Level II code · G codes: Procedures / Professional Services (Temporary)
HCPCS codeG9667
- Long description
- Documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy)
- Short description
- Doc med rsn no stat tx/presc
- Pricing indicator
00Not separately priced by Part B (bundled, not covered or Part A only)- Medicare coverage
CCarrier judgment – coverage decided by the Medicare contractor- BETOS category
Z2Undefined codes- Added
- January 1, 2016
- Last change
- January 1, 2017 – No change
- Termination date
- December 31, 2016
Frequently asked questions
What is HCPCS code G9667?
G9667 is a HCPCS Level II code for documentation of medical reason(s) for not currently being a statin therapy user or receive an order (prescription) for statin therapy (e.g., patient with adverse effect, allergy or intolerance to statin medication therapy, patients who have an active diagnosis of pregnancy or who are breastfeeding, patients who are receiving palliative care, patients with active liver disease or hepatic disease or insufficiency, patients with end stage renal disease (esrd), and patients with diabetes who have a fasting or direct ldl-c laboratory test result < 70 mg/dl and are not taking statin therapy). It was discontinued on December 31, 2016.
Does Medicare cover G9667?
The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby G codes
- G9659 – Patients greater than or equal to 86 years of age who underwent a screening colonoscopy and did not have a history of colorectal cancer or other valid medical reason for the colonoscopy, including: iron deficiency anemia, lower gastrointestinal bleeding, familial adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits
- G9660 – Documentation of medical reason(s) for a colonoscopy performed on a patient greater than or equal to 86 years of age (e.g., iron deficiency anemia, lower gastrointestinal bleeding, familial history of adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis colorectal cancer), inflammatory bowel disease (i.e., crohn's disease or ulcerative colitis), abnormal finding of gastrointestinal tract, weight loss, or changes in bowel habits)
- G9661 – Patients greater than or equal to 86 years of age who received a colonoscopy for an assessment of signs/symptoms of gi tract illness, and/or because the patient meets high risk criteria, and/or to follow-up on previously diagnosed advanced lesions
- G9662 – Previously diagnosed or have a diagnosis of clinical ascvd, including ascvd procedure
- G9663 – Any ldl-c laboratory result >= 190 mg/dl
- G9664 – Patients who are currently statin therapy users or received an order (prescription) for statin therapy
- G9665 – Patients who are not currently statin therapy users or did not receive an order (prescription) for statin therapy
- G9666 – Patient's highest fasting or direct ldl-c laboratory test result in the measurement period or two years prior to the beginning of the measurement period is 70-189 mg/dl
- G9669 – I intend to report the multiple chronic conditions measures group
- G9670 – All quality actions for the applicable measures in the multiple chronic conditions measures group have been performed for this patient
- G9671 – I intend to report the diabetic retinopathy measures group
- G9672 – All quality actions for the applicable measures in the diabetic retinopathy measures group have been performed for this patient
- G9673 – I intend to report the cardiovascular prevention measures group
- G9674 – Patients with clinical ascvd diagnosis
- G9675 – Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 mg/dl
- G9676 – Patients aged 40 to 75 years at the beginning of the measurement period with type 1 or type 2 diabetes and with an ldl-c result of 70-189 mg/dl recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.