G9940 — 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)
G9940 is a HCPCS Level II code for 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). It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9940
- Long descriptor
- 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)
- Short descriptor
- Doc reas no statin therapy
- Added
- January 1, 2018
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G9940
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9940 is not quite right, the correct code is very often within a few positions of it.
- G9932Documentation of patient reason(s) for not having records of negative or managed positive tb screen (e.g., patient does not return for mantoux (ppd) skin test evaluation)terminated
- G9933Adenoma(s) or colorectal cancer detected during screening colonoscopyterminated
- G9934Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenomaterminated
- G9935Adenoma(s) or colorectal cancer not detected during screening colonoscopyterminated
- G9936Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anusterminated
- G9937Diagnostic colonoscopyterminated
- G9938Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
- G9939Pathologists/dermatopathologists is the same clinician who performed the biopsy
- G9941Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperativelyterminated
- G9942Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomyterminated
- G9943Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively
- G9944Back pain was measured by the visual analog scale (vas) within three months preoperatively and at one year (9 to 15 months) postoperativelyterminated
- G9945Patient had cancer, acute fracture or infection related to the lumbar spine or patient had neuromuscular, idiopathic or congenital lumbar scoliosis
- G9946Back pain was not measured by the visual analog scale (vas) or numeric pain scale at one year (9 to 15 months) postoperatively
- G9947Leg pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 to 20 weeks) postoperativelyterminated
- G9948Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomyterminated
Questions about G9940
What is HCPCS code G9940?
G9940 is a HCPCS Level II code for 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). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9940?
The CMS HCPCS file marks G9940 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G9940 paid under the physician fee schedule?
G9940 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.