G0249, Provision of test materials and equipment for home inr monitoring of patient
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
$65.80
Non-Facility
$65.80
Documentation Required
- The number of completed tests must be included in the claim narrative for Part B: 5010A1 837P Loop 2400 or SV101-7 for electronic claims, and Item 19 for paper claims.
- For Part A submit the number of completed tests in Line SV202-7 on the 837I electronic claim or Block 80 on the UB-04 form.
- Clinical records must document test results and, when early/duplicate testing is claimed, the reasonable clinical cause for the early test(s).
- When partial billing is submitted because testing will not continue (withdrawal, death, transfer), append modifier -52 and indicate the number of tests completed; charges must be decremented proportionally (75%, 50%, or 25%).
Key Coverage Criteria
- Medicare covers home PT/INR monitoring using HCPCS G0249 for beneficiaries who meet the coverage criteria in Medicare NCD 190.11.
- Coverage is for one home PT/INR test per calendar week (Sunday–Saturday) with billing occurring after completion and reporting of four tests to the treating physician (one unit of service).
- Persons who require chronic oral anticoagulation with warfarin for a mechanical heart valve
- Persons who require chronic oral anticoagulation with warfarin for a ventricular assist device
- Persons who require chronic oral anticoagulation with warfarin for chronic atrial fibrillation
- Persons who require chronic oral anticoagulation with warfarin for deep venous thrombosis
3 Active Policies
ANTHEM-CG-DME-30, CG-DME-30 Prothrombin Time Self-Monitoring Devices
A55754, Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding
AETNA-CPB-0173, Prothrombin Time (INR) Home Testing Devices
Related Codes
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