Meet G0249-G0250 Requirements to Prevent Delays
You may know which code accurately describes a physician’s services for test materials and equipment for home international normalized ratio (INR) monitoring and review, but you’ll need more than just the right code to get paid for such services. Jurisdiction 1-Medicare administrative contractor (J1-MAC) Palmetto GBA recently published a provider education article on its website addressing the correct billing, service, and documentation requirements for HCPCS Level II codes G0249 and G0250.
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; testing not occurring more frequently than once a week; testing materials, billing units of service include four tests.
G0250- Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include four tests.
Code G0249 requires not only the provision of test materials and equipment to eligible beneficiaries, but also the reporting of test results to the physician. To meet the service requirement, testing is limited to once per week, and G0249 requires that four tests be performed and results reported to the physician. Health records lacking information regarding when and how the physician was notified would not meet the service requirement necessary to submit G0249.
Physicians submitting claims for HCPCS Level II code G0250 should record the results of home INR testing and ensure that each of the four test results reviewed are documented.
Adhering to this guidance will promote correct coding and payment and decrease potential delays in reimbursement due to record reviews.
Source: Palmetto GBA