Your ratio of hdl to ldl is more important than your total. They most probably will not put you on medication.
My total has gone from 244 to 218 from cycling and eating well. I asked about medication at one point, but they wouldn't even consider it, because my hdl was 81-- the highest the doctor had ever seen. My hdl is now about 75, which is still way above what it needs to be. I would still like to get the total below 200, but it's taking a long time to do that!
As long as your ldl isn't too bad and your triglycerides are low, diet and exercise will be the first line of defense.