Effective April 1, 2013 and while Sequestration is in effect, all Medicare payments for services will
be reduced by 2%.
The Medicare fees below do not reflect this reduction. Click here for more information.
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Home PT/INR Monitoring
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||HCPC Code Description
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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
|| CCI NCD
||HCPC Code Description
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 AND CARE OF THE INR MONITOR, OBTAINING AT LEAST ONE BLOOD SAMPLE, PROVISION OF INSTRUCTIONS FOR REPORTING HOME INR TEST RESULTS, AND DOCUMENTATION OF PATIENT'S ABILITY TO PERFORM TESTING AND REPORT RESULTS
|| CCI NCD
PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WITH EITHER MECHANICAL HEART VALVE(S), CHRONIC ATRIAL FIBRILLATION, OR VENOUS THROMBOEMBOLISM WHO MEETS MEDICARE COVERAGE CRITERIA; INCLUDES: PROVISION OF MATERIALS FOR USE IN THE HOME AND REPORTING OF TEST RESULTS TO PHYSICIAN; TESTING NOT OCCURRING MORE FREQUENTLY THAN ONCE A WEEK; TESTING MATERIALS, BILLING UNITS OF SERVICE INCLUDE 4 TESTS
1NCD, National Coverage Determination
2Centers for Medicare and Medicaid National Physician Fee Schedule 2016,
available at https://www.cms.gov/PhysicianFeeSched/
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was obtained from publicly available sources, and is subject to change without notice. All content on this website
is for informational purposes only, is general in nature, and does not cover all situations or all payers' rules and policies.
Alere cannot guarantee or promise coverage or payment for any particular item or service from any payer
or health benefit plan. To be eligible for coverage, an item or service must be medically necessary for the individual
patient, have been performed as reported, and appropriate documentation should be available in the patient's medical record.
It is the individual provider's responsibility to determine appropriate, medically necessary coding, charges and claims for a particular service.
Providers are responsible for determining medical necessity for all Medicare recognized panel tests.
To be eligible for coverage, each component test must be medically necessary for the individual patient.
In addition, for tests grouped on single cassettes or cartridges, providers are responsible for determining
the medical necessity of each test for each patient. Laws, regulations and payer policies regarding appropriate
coding and payment levels can vary greatly from payer to payer and change over time. Alere recommends
that providers contact their own regional payers to determine appropriate coding and charge or payment levels.
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