HCPCS for Carriers
For services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:
G0248: Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results and documentation of a patient’s ability to perform testing.
G0249: Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria. Includes provision of materials for use in the home and reporting of test results to physician; per 4 tests.
G0250: Physician review; interpretation and patient management of home INR testing for a patient with mechanical heart valve(s) who meets other coverage criteria; per 4 tests (does not require face-to-face).
Coverage and Billing for Home Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management
The prothrombin time (PT) test is an in-vitro test to assess coagulation. PT testing and its normalized correlate, the International Normalized Ratio (INR), are the standard measurements for therapeutic effectiveness of warfarin therapy. Warfarin, Coumadin®, and others, are self-administered, oral anticoagulant, or blood thinner, medications that affect a person’s Vitamin K-dependent clotting factors.
Use of the 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.
Coverage Requirements
For services furnished on or after July 1, 2002, Medicare will cover the use of home INR monitoring for anticoagulation management for patients with mechanical heart valves on warfarin. The monitor and the home testing must be prescribed by a physician and the following patient requirements must be met:
• Must have been anticoagulated for at least 3 months prior to use of the home INR device;
• 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.
For services furnished on or after March 19, 2008, the Centers for Medicare & Medicaid Services revised its national coverage determination (NCD) on PT/INR Monitoring for Home Anticoagulation Management as follows:
Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin. The monitor and the home testing must be prescribed by a treating physician as provided at 42 CFR 410.32(a), and all of the following requirements must be met:
1. The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,
2. The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,
3. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,
4. Self-testing with the device should not occur more frequently than once a week.
NOTE: Porcine valves are not included in this NCD, so Medicare will not make payment on home INR monitoring for patients with porcine valves unless covered by local Medicare contractors.
ICD-10-CM Code Code Description
D68.51
Activated protein C resistanc
D68.52
Prothrombin gene mutation
D68.59
Other primary thrombophilia
D68.61
Antiphospholipid syndrome
D68.62
Lupus anticoagulant syndrome
Phlebitis & Thrombophlebitis
ICD-10-CM Code Code Description
I80.00
Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity
I80.01
Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02
Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03
Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.10
Phlebitis and thrombophlebitis of unspecified femoral vein
I80.11
Phlebitis and thrombophlebitis of right femoral vein
I80.12
Phlebitis and thrombophlebitis of left femoral vein
I80.13
Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201
Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202
Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203
Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.209
Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity
I80.221
Phlebitis and thrombophlebitis of right popliteal vein
I80.222
Phlebitis and thrombophlebitis of left popliteal vein
I80.223
Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.229
Phlebitis and thrombophlebitis of unspecified popliteal vein
I80.231
Phlebitis and thrombophlebitis of right tibial vein
I80.232
Phlebitis and thrombophlebitis of left tibial vein
I80.233
Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.239
Phlebitis and thrombophlebitis of unspecified tibial vein
I80.291
Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292
Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293
Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.299
Phlebitis and thrombophlebitis of other deep vessels of unspecified lower extremity
I80.3
Phlebitis and thrombophlebitis of lower extremities, unspecified
I80.211
Phlebitis and thrombophlebitis of right iliac vein
I80.212
Phlebitis and thrombophlebitis of left iliac vein
I80.213
Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.219
Phlebitis and thrombophlebitis of unspecified iliac vein
I80.8
Phlebitis and thrombophlebitis of other sites
I80.9
Phlebitis and thrombophlebitis of unspecified site
Other Venous Embolism & Thrombosis
ICD-10-CM Code Code Description
I82.0
Budd- Chiari syndrome
I82.1
Thrombophlebitis migrans
I82.211
Chronic embolism and thrombosis of superior vena cava
I82220
Acute embolism and thrombosis of inferior vena cava
I82.221
Chronic embolism and thrombosis of inferior vena cava
I82.291
Chronic embolism and thrombosis of other thoracic veins
I82.3
For services furnished on or after July 1, 2002, and prior to March 19, 2008, the applicable HCPCS codes for this benefit are:
G0248: Demonstration, at initial use, of home INR monitoring for patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results and documentation of a patient’s ability to perform testing.
G0249: Provision of test materials and equipment for home INR monitoring to patient with mechanical heart valve(s) who meets Medicare coverage criteria. Includes provision of materials for use in the home and reporting of test results to physician; per 4 tests.
G0250: Physician review; interpretation and patient management of home INR testing for a patient with mechanical heart valve(s) who meets other coverage criteria; per 4 tests (does not require face-to-face).
Coverage and Billing for Home Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management
The prothrombin time (PT) test is an in-vitro test to assess coagulation. PT testing and its normalized correlate, the International Normalized Ratio (INR), are the standard measurements for therapeutic effectiveness of warfarin therapy. Warfarin, Coumadin®, and others, are self-administered, oral anticoagulant, or blood thinner, medications that affect a person’s Vitamin K-dependent clotting factors.
Use of the 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.
Coverage Requirements
For services furnished on or after July 1, 2002, Medicare will cover the use of home INR monitoring for anticoagulation management for patients with mechanical heart valves on warfarin. The monitor and the home testing must be prescribed by a physician and the following patient requirements must be met:
• Must have been anticoagulated for at least 3 months prior to use of the home INR device;
• 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.
For services furnished on or after March 19, 2008, the Centers for Medicare & Medicaid Services revised its national coverage determination (NCD) on PT/INR Monitoring for Home Anticoagulation Management as follows:
Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin. The monitor and the home testing must be prescribed by a treating physician as provided at 42 CFR 410.32(a), and all of the following requirements must be met:
1. The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,
2. The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,
3. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,
4. Self-testing with the device should not occur more frequently than once a week.
NOTE: Porcine valves are not included in this NCD, so Medicare will not make payment on home INR monitoring for patients with porcine valves unless covered by local Medicare contractors.
ICD-10-CM Code Code Description
D68.51
Activated protein C resistanc
D68.52
Prothrombin gene mutation
D68.59
Other primary thrombophilia
D68.61
Antiphospholipid syndrome
D68.62
Lupus anticoagulant syndrome
Phlebitis & Thrombophlebitis
ICD-10-CM Code Code Description
I80.00
Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity
I80.01
Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02
Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03
Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.10
Phlebitis and thrombophlebitis of unspecified femoral vein
I80.11
Phlebitis and thrombophlebitis of right femoral vein
I80.12
Phlebitis and thrombophlebitis of left femoral vein
I80.13
Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201
Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202
Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203
Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.209
Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity
I80.221
Phlebitis and thrombophlebitis of right popliteal vein
I80.222
Phlebitis and thrombophlebitis of left popliteal vein
I80.223
Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.229
Phlebitis and thrombophlebitis of unspecified popliteal vein
I80.231
Phlebitis and thrombophlebitis of right tibial vein
I80.232
Phlebitis and thrombophlebitis of left tibial vein
I80.233
Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.239
Phlebitis and thrombophlebitis of unspecified tibial vein
I80.291
Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292
Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293
Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.299
Phlebitis and thrombophlebitis of other deep vessels of unspecified lower extremity
I80.3
Phlebitis and thrombophlebitis of lower extremities, unspecified
I80.211
Phlebitis and thrombophlebitis of right iliac vein
I80.212
Phlebitis and thrombophlebitis of left iliac vein
I80.213
Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.219
Phlebitis and thrombophlebitis of unspecified iliac vein
I80.8
Phlebitis and thrombophlebitis of other sites
I80.9
Phlebitis and thrombophlebitis of unspecified site
Other Venous Embolism & Thrombosis
ICD-10-CM Code Code Description
I82.0
Budd- Chiari syndrome
I82.1
Thrombophlebitis migrans
I82.211
Chronic embolism and thrombosis of superior vena cava
I82220
Acute embolism and thrombosis of inferior vena cava
I82.221
Chronic embolism and thrombosis of inferior vena cava
I82.291
Chronic embolism and thrombosis of other thoracic veins
I82.3