Other Services
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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