International Normalized Ratio Home Monitoring - JE Part B

Medicare will reimburse for the use of HCPCS G0249, (provision of International Normalized Ratio (INR) test material/equipment). See CMS Internet Only Manual (IOM), Publication 100-03, Medicare National Determinations (NCD) Manual, Chapter 1, Part 3, Section 190.11.

Coverage and Documentation

CMS IOM, Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, Section 190.11 discusses home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation or venous thromboembolism on warfarin.

A PT/INR monitoring system is a portable testing device that includes a finger stick and an FDA-cleared meter that measures the time it takes for a person's blood plasma to clot. The monitor and home testing must be prescribed by a treating physician.

Medical Documentation Requirements

• Patient must have been anticoagulated for at least three months prior to use of home INR device
• Patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated correct use of device prior to its use in home
• Patient continues to correctly use device in context of management of anticoagulation therapy following initiation of home monitoring
• Self testing with device should not occur more frequently than once per week
• Signed and dated clinical documentation* of intent of ordering for billed provision of test materials and equipment for home INR monitoring of patient. (*Progress notes from ordering physician)