G0250, Physician review, interpretation, and patient management of home inr testing
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.18
Facility
$9.02
Non-Facility
$9.02
Documentation Required
- Documentation of face-to-face patient/caregiver training for initiation of home INR monitoring, including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient's/caregiver's ability to perform testing and report results (CPT 93792 / G0248).
- Documentation that the patient underwent an educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home (CMS decision memo requirement referenced in policy).
- Documentation that the patient has been anticoagulated for at least 3 months prior to use of the home INR device and that expected need for home INR testing is for 6 or more months.
- Physician documentation of prescription/order for the home PT/INR monitor and ongoing management/supervision of home testing.
Key Coverage Criteria
- 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
- Persons who require chronic oral anticoagulation with warfarin for pulmonary embolism
- Persons who require chronic oral anticoagulation with warfarin for venous embolism and thrombosis of deep vessels of lower extremity
2 Active Policies
ANTHEM-CG-DME-30, CG-DME-30 Prothrombin Time Self-Monitoring Devices
AETNA-CPB-0173, Prothrombin Time (INR) Home Testing Devices
Related Codes
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