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Medical Coding News Archives

CMS Announces New Coverage of Home PT Monitoring

 
August 12, 2008:
The Centers for Medicare and Medicaid Services (CMS) announced a revision to National Coverage Determination 190.11 on July 25 that provides coverage for the use of home PT (Prothrombin Time) /INR (Internation Normalized Ratio)monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) who are on warfarin. Prior to this revision, coverage was mandated only for patients with mechanical heart valves.

In order to meet coverage requirements, the following criteria must be met:
  • The patient must have been anticoagulated for at least 3 months prior to use of the home INR device
  • The patient must undergo a face-to-face educational program on anticoagulation management and the use of the home monitoring device prior to it’s use
  • Self-testing should not occur more frequently than once a week
  • The patient uses the device correctly following initiation of home monitoring
The following HCPCS Level II codes will continue to be used for reporting the services connected to home INR monitoring.

G0248: Demonstration, prior to initial use, of home INR monitoring for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient ability to perform testing prior to its use

G0249: Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting of test results to physician; not occurring more frequently than once a week

G0250: Physician review, interpretation, and patient management of home INR testing for a patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes face-to-face verification by the physician that the patient uses the device in the context of the management of the anticoagulation therapy following initiation of the home INR monitoring; not occurring more frequently than once a week.

It is important to note that porcine valves are not included in this NCD, so Medicare will not make payment on Home INR monitoring for patients with porcine valves unless covered by local Medicare contractors.

Medicare has instructed contractors to process and pay for the expanded home PT/INR monitoring for dates of service beginning March 19.

Deborah C. Hall
Clinical Technical Editor

 

 
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