(Medicare Claims Processing Manual)

Coverage policy can be found in Pub. 100- 03, Medicare National Coverage Determinations Manual, Chapter 1, section 190.11 PT/INR. (http://www.cms.hhs.gov/manuals/103_cov_determ/ncd103index.asp   60.4.2  Healthcare Common Procedure Cod ing System (HCPCS) for Intermediaries  (Rev. 1562, Issued: 07- 25-08, Effective: 03-19-08, Implementation: 08-25-08)  For services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:   G0248: Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration 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 a patients ability to perform testing.   Short Description:  Demonstrate use home INR mon  G0249:  Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria.  Includes provision of materials for use in the home and reporting of test results to physician; per 4 tests.  Short Description:  Provide test material, equipm  For services furnished on or after March 19, 2008, the applicable HCPCS codes for this benefit are:   G0248:  Demonstration, prior to initial use, 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 ability to perform testing prior to its use   Short Description :  Demonstrate use home INR mon  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; not occurring more frequently than once a week   Short Description:  Provide INR test mater/equip   60.5  Carrier Billing Instructions  (Rev. 1562, Issued: 07- 25-08, Effective: 03 -19-08, Implementation: 08- 25-08)  Effective for claims with dates of service on and after March 19, 2008, the descriptors of HCPCS Codes G0248, G0249, and G0250 were changed to reflect revised coverage policy.   60.5.1 - HCPCS for Carriers (Rev. 1562, Issued: 07- 25-08, Effective: 03 -19-08, Implementation: 08- 25-08)  For services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:   G0248:  Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration 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 a patients ability to perform testing.   Short Description:  Demonstrate use home INR mon  G0249:  Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria.  Includes provision of materials for use in the home and reporting of test results to physician; per 4 tests.  Short Description:  Provide test material, equipm  G0250:  Physician review; interpretation and patient management of home INR testing for a patient with mechanical heart valve(s) who meets other coverage criteria; per 4 tests (does not require face- to-face).   Short Description :  MD review interpret of test   For services furnished on or after March 19, 2008, the applicable HCPCS codes for this benefit are:   G0248:   Demonstration, prior to initial use, 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 ability to perform testing prior to its use   Short Description :  Demonstrate use home INR mon  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 t he home and reporting of test results to physician; not occurring more frequently than once a week   Short Description:  Provide INR test mater/equip   G0250:  Physician review, interpretation, and patient management of home INR testing for a patient with either mechanical heart valve(s), chronic atrial fibrillation, or  venous thromboembolism who meets Medicare coverage criteria; includes face- to-face verificatio n 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; not occurring more frequently than once a week   Short Description :  MD INR test revie inter mgmt  60.5.2  Applicable Diagnosis Codes for A/B MACs (B)  (Rev.10881; Issued: 08- 06-2021; Effective: 09- 07-2021; Implementation: 09- 07- 2021)    For services furnished on or after the implementation of ICD -10 the applicable ICD -10-CM diagnosis codes for this benefit are: