CG-DME-30 Prothrombin Time Self-Monitoring Devices

This policy addresses home prothrombin time/INR self-monitoring devices and testing for individuals on warfarin. It is medically necessary when the patient requires long-term (>1 year) warfarin therapy, needs at least weekly INR measurements, and the treating physician prescribes the device and home testing; candidates should receive physician-supervised training and demonstrate competency and willingness to self-test. Home PT/INR self-monitoring is not medically necessary if these criteria are not met.

"Home prothrombin time self-monitoring using an INR device isconsideredmedically necessaryfor an individual who meetsallof the following criteria:"

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