NCD Determines PT/INR Monitoring Covered

For services furnished on or after March 19, 2008, Medicare will cover the use of home prothrombin time tests adjusted to the International Normalized Ratio (PT/INR) 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) on warfarin. This addition/revision is a national coverage determination (NCD) found in the Medicare National Coverage Determinations Manual, Chapter 1, Part 3 (Sections 170 – 190.34), Coverage Determinations.
Applicable HCPCS Level II codes are:

  • G0248 Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstrating 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
  • G0249 Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria; includes provision of materials for use in the home and reporting of test results to physician; per 4 tests
  • G0250 Physician review, interpretation and patient management of home INR testing for a patient with mechanical heart valve(s) who meets other coverage criteria; per 4 tests (does not require face-to-face service)

With the July 2008 OCE and MPFS updates, the descriptors of these codes are changing to reflect the revised coverage policy. The new descriptors reflect the expanded NCD criteria and are effective March 19; however, they have not been posted on the CMS Web site yet.
For requirements and other details, read CMS Transmittal 90, dated July 25, MLN Matters article MM6138, and NCD 190.11 on the CMS Web site.

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