Does Medicare cover G0248?

Medicare will cover the use of home 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.

Is G0248 a DME?

These are Contractor priced, although there are RVUs in the fee schedule. They were not deleted with the addition of the CPT® codes. G0248 is similar to the new CPT® code 93972. This is not a DME benefit but is a paid under the physician fee schedule.

Is 93793 covered by Medicare?

Unlike codes 99363 and 99364, which Medicare considered “bundled,” codes 93792 and 93793 are separately payable under the Medicare physician fee schedule.

What is G0248?

G0248 is a valid 2021 HCPCS code for Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use …

How do I monitor my INR?

If the dose of warfarin is too high, the patient may be at risk of serious bleeding. It can be monitored by drawing blood from a vein and sending the blood to an accredited laboratory to test, or it can be monitored by testing blood from a fingerstick with an INR test meter outside of a laboratory.

How do you bill for Coumadin management?

CPT code 99211 is the lowest level evaluation and management (E/M) service and does not require a physician face-to-face encounter with the patient.

What does INR mean?

The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin (Coumadin®). The PT and INR are used to monitor the effectiveness of the anticoagulant warfarin.

How often can CPT 93793 be billed?

This service is payable only once every 4 weeks. The date of service is the date of the fourth test interpretation. For 2018, there is also code 93793 describing the physician interpretation and instructions. The appropriate date of service is the date of the review.

How much does home INR testing cost?

The price for the devices ranges widely, from $600 to more than $3,000, and the price for test strips ranges from $7 to $18 per test. You should note that in some cases the online retailers of these devices have not been authorized by the device manufacturer to distribute the device.

Does Medicare pay for Coumadin Clinic?

The good news is that Medicare now covers self INR testing, provided you have been on anticoagulant drugs for at least three months before commencing the use of a coagulation meter. Since March 19, 2008, Medicare has effectively covered 80% of the service once you’ve been able to meet up with the annual deductible.

What do you need to know about g0250?

G0250 requires “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.” The frequency of the face-to-face verification is not listed in the code.

What does the g0249 stand for in CPT code?

G0249 — supplies along with the monitor The DOS is the date the supplies and monitor are given to the patient. 3. G0250 — physician interpretation of the test results and face-to-face verification that the patient is using the device. This service is payable only once every four weeks. The DOS is the date of the fourth test interpretations.

What is the difference between g0250 and 93793?

Is the g0249 benefit a DME benefit?

G0249 includes providing the machine and materials for INR testing. This is not a DME benefit but is a paid under the physician fee schedule. The practice provides the machine that the patient uses to test their blood.