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Chapter 8
Section 2.5
Home Prothrombin Time (PT)
International Normalized Ratio (INR) Monitor
Issue Date: March 3, 2005
Revision:
1.0 HCPCS
PROCEDURE CODES
G0248, G0249, G0250
2.0 DESCRIPTION
Home PT INR monitoring devices are portable,
battery-operated, hand-held analyzing systems designed for testing
a small sample of fresh, capillary whole blood obtained by a finger-stick
using a lancet device. Depending on the system, the drop of blood
is placed on a test strip or disposable reagent cuvette. A new test
strip or reagent cartridge must be used with each test performed.
Once clotting is initiated, PT is determined by different ways depending
on the device:
• By cessation of blood
flow;
• By
changes in light transmission;
• Through use of
fluorescent thrombin substrate.
3.0 POLICY
3.1 Home PT
INR monitors may be covered for patients meeting the following criteria:
3.1.1 The patient
must have a medical condition requiring lifetime warfarin therapy
and monitoring of prothrombin time activity.
3.1.2 The patient
must need to have frequent prothrombin time testing once a week
or multiple times per month.
3.1.3 The patient (or patient’s
caregiver) must have the ability to use the prothrombin time monitoring
device after obtaining education on its proper use from an appropriate
health care professional.
3.2 The monitor must be prescribed
by a physician.
3.3 The device must have U.S.
Food and Drug Administration (FDA) approval.
3.4 Related
services and supplies, such as PT test strips and office visits,
are covered.
3.5 Education or demonstration related to the use
of the device is considered incidental to the office visit or the
provision of the materials and equipment. Additional reimbursement
is not warranted.
4.0 EFFECTIVE
DATE
Date of FDA approval of the device.
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