G8474 HCPCS code: Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)
G8474 is the HCPCS Level II code for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons). Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | M5D |
| Added | 2008-01-01 |
| Last action effective | 2024-01-01 |
What changed for G8474
- 2008-01-01: G8474 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G8474?
G8474 is the HCPCS Level II code for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons). Short descriptor: "Ace/arb not rx'd; doc reas".
Does Medicare cover G8474?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G84 codes
- G8400 — Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given
- G8401 — Clinician documented that patient was not an eligible candidate for screening
- G8404 — Lower extremity neurological exam performed and documented
- G8405 — Lower extremity neurological exam not performed
- G8406 — Clinician documented that patient was not an eligible candidate for lower extremity neurological exam measure
- G8410 — Footwear evaluation performed and documented
- G8415 — Footwear evaluation was not performed
- G8416 — Clinician documented that patient was not an eligible candidate for footwear evaluation measure
- G8417 — Bmi is documented above normal parameters and a follow-up plan is documented
- G8418 — Bmi is documented below normal parameters and a follow-up plan is documented
- G8419 — Bmi documented outside normal parameters, no follow-up plan documented, no reason given
- G8420 — Bmi is documented within normal parameters and no follow-up plan is required
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Next steps
- Run a reimbursement report for a device billed under G8474
- Watch G8474 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8474
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.