Statin medication, specifically for diabetes or other heart diseases, has been proven to help prevent cardiovascular events. However, it might not be clinically appropriate for every patient due to an intolerance or contraindication.

Statin therapy does get measured via claims data and diagnosis code for quality purposes to determine which members should be included or excluded from such quality measures. If a patient is not a candidate for statin therapy, it is important to include the appropriate ICD-10 code(s) on claims, so the patient is not included in quality measures. The ICD-10 code should be submitted on at least one claim every year. For more details on how we measure, please refer to the CMS Technical Specifications, specifically the Statin Use in Persons with Diabetes (SUPD) section.

Below are some conditions that prevent statin medication use and help us identify ineligible members.

Condition	Appropriate code
Pregnancy	G9778
Hospice care	G9473-G9479
Cirrhosis	K70.30, K70.31, K71.7, K74.3, K74.4, K74.5, K74.60, K74.69
Dialysis procedure	G0257
End stage renal disease	N18.6
IVF procedure	S4015, S4016, S4018, S4020, S4021
Myalgia	M79.1-M79.18
Myositis	M60.80-M60.819, M60.821-M60.829, M60.831-M60.839, M60.841-M60.849, M60.851-M60.859, M60.861-M60.869, M60.871-M60.879, M60.88-M60.9
Myopathy	G72.0, G72.2, G72.9
Rhabdomyolysis	M62.82