CPT code G0248, G0249, G0250 - Demonstrate use home

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

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