Article Detail - JD DME

Original Effective Date: 12/06/2001
Revision Effective Date: 11/01/2013

In a September 18, 2001, National Coverage Decision Memorandum, the Centers for Medicare and Medicaid Services (CMS) stated that home prothrombin time (INR) monitors used to manage anticoagulation are only eligible for coverage under the diagnostic services benefit. That is to say that individual tests performed by the patient or caregiver using the device can be considered for coverage. However, these tests must be billed by a laboratory to the local carrier or local intermediary. There is no coverage for the monitor or related supplies under the durable medical equipment benefit or any other benefit administered by the DMERC. If claims for these items are received by the DMERC, they will be denied as incorrect billing jurisdiction. Claims denied for this reason are not eligible for appeal through the DMERC.