Does G0250 require prior authorization?

No, G0250 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0250?

Medicare facility rate: $9.02. Non-facility rate: $9.02. Work RVU: 0.18.

Verity

`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 4 tests

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.

Documentation of physician review, interpretation and patient management of home INR testing results, including review/interpretation of a new home/office/lab INR test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s) when performed (CPT 93793 / G0250).

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 (G0250).

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

AETNA-CPB-0173 — Prothrombin Time (INR) Home Testing Devices

ANTHEM-CG-DME-30 — CG-DME-30 Prothrombin Time Self-Monitoring Devices

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