For services on or after December 31, 2007, see policy N-7.
Use of the International Normalized Ratio (INR) allows physicians to determine the level of anticoagulation in a patient, independent of the laboratory reagents used. The INR is the ratio of the patient’s prothrombin time compared to the mean prothrombin time for a group of normal individuals.
Maintaining patients within the therapeutic range minimizes adverse events associated with inadequate or excessive anticoagulation, such as serious bleeding or thromboembolic events.
Patient self-testing and self-management through the use of a home INR monitor may be used to improve the time in therapeutic rate (TTR) for select groups of patients. Increased TTR leads to improved clinical outcomes and reductions in thromboembolic and hemorrhagic events.
Indications and Limitations of Coverage
The use of home prothrombin time INR monitoring is covered for anticoagulation management for patients with mechanical heart valves on warfarin when all the following criteria are met:
- A physician must prescribe the monitor and the home testing;
- The patient must have been anticoagulated for at least three months prior to use of the home INR device;
- The patient must undergo an educational program on anticoagulation management and the use of the device prior to its use in the home; and
Self-testing with the device is limited to a frequency of once per week.
- Special consideration may be given in individual situations for homebound patients receiving anticoagulant therapy who do not have a mechanical heart valve, when visits to a laboratory for prothrombin time testing are not possible due to the patient's medical condition.
Porcine valves are not covered. Therefore, no payment will be made for home INR monitoring for patients with porcine valves.
Procedure code G0249 includes payment for both the device and the supplies. These items may not be separately billed. Procedure code G0249 is not covered as durable medical equipment.
Procedure code G0250 is per four tests. Self-testing with the INR monitor is limited to once weekly. Therefore, this code should not be billed more than once every four weeks.
NCD for Home Prothrombin Time INR Monitoring for Anticoagulation Management (190.11)
Transmittal AB-02-180, CR 2323