Home prothrombin time (PT) / INR monitoring
This policy governs billing, coding, documentation, and coverage considerations for home PT/INR monitoring (including training, provision of supplies, and review/management) for Priority Health members, and clarifies Medicare-specific guidance where applicable.
No material clinical or coverage changes in this revision.
Coverage and Billing Criteria
Coverage criteria and billing rules
Coverage and billing depend on meeting coding, Medicare/NCD/LCD criteria, and documentation requirements; a Pre‑Service Organization Determination (PSOD) may be required for Medicare when criteria are not met.
ALL of the following
ALL of the following
- When indications do not meet NCD, a local LCD, or a specific medical policy, a Pre-Service Organization Determination (PSOD) is required for Medicare members.
ALL of the following
- Use the following CPT/HCPCS codes as described: 93792 (patient/caregiver training for initiation of home INR monitoring); 93793 (anticoagulant management including review/interpretation of INR, instructions, dosage adjustment); G0248 (demonstration prior to initial use for Medicare-eligible indications); G0249 (provision of test materials and equipment for Medicare-eligible indications); G0250 (physician review, interpretation, and patient management for Medicare-eligible indications).
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