G8816 HCPCS code: Statin medication prescribed at discharge
G8816 is the HCPCS Level II code for statin medication prescribed at discharge. 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 | M5B |
| Added | 2012-01-01 |
| Last action effective | 2012-01-01 |
What changed for G8816
- 2012-01-01: G8816 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 G8816?
G8816 is the HCPCS Level II code for statin medication prescribed at discharge. Short descriptor: "Statin med pres at disch".
Does Medicare cover G8816?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G88 codes
- G8806 — Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
- G8807 — Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
- G8808 — Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
- G8809 — Rh-immunoglobulin (rhogam) ordered
- G8810 — Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
- G8811 — Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
- G8815 — 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)
- G8817 — Statin therapy not prescribed at discharge, reason not given
- G8818 — Patient discharge to home no later than post-operative day #7
- G8825 — Patient not discharged to home by post-operative day #7
- G8826 — Patient discharged to home no later than post-operative day #2 following evar
- G8833 — Patient not discharged to home by post-operative day #2 following evar
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Next steps
- Run a reimbursement report for a device billed under G8816
- Watch G8816 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8816
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.