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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
HCPC Code Description
Medicare Coverage1
Please select a state.
Reimbursement2
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
CCI   NCD  


HCPC Code
HCPC Code Description
Medicare Coverage1
G0248
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  
G0249
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
NCD  


Frequently Asked Questions Regarding Billing and Medicare Coverage
of Home PT/INR Monitoring












1NCD, National Coverage Determination

2Centers for Medicare and Medicaid National Physician Fee Schedule 2016, available at https://www.cms.gov/PhysicianFeeSched/

The information provided on this website is current as of 05/04/2016, 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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