Does G0249 require prior authorization?

No, G0249 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0249?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0249`, Provision of test materials and equipment for home inr monitoring of patient

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The number of completed tests must be included in the claim narrative for Part B: 5010A1 837P Loop 2400 or SV101-7 for electronic claims, and Item 19 for paper claims.
For Part A submit the number of completed tests in Line SV202-7 on the 837I electronic claim or Block 80 on the UB-04 form.

When partial billing is submitted because testing will not continue (withdrawal, death, transfer), append modifier -52 and indicate the number of tests completed; charges must be decremented proportionally (75%, 50%, or 25%).

If extra home tests will be charged to the beneficiary, the provider should obtain a written order and provide an Advance Beneficiary Notice (ABN) and append the appropriate ABN modifier to the claim.

Documentation of face-to-face patient/caregiver training for initiation of home INR monitoring, including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient's/caregiver's ability to perform testing and report results (CPT 93792 / G0248).

Key Coverage Criteria

Medicare covers home PT/INR monitoring using HCPCS G0249 for beneficiaries who meet the coverage criteria in Medicare NCD 190.11.
Coverage is for one home PT/INR test per calendar week (Sunday–Saturday) with billing occurring after completion and reporting of four tests to the treating physician (one unit of service).
Persons who require chronic oral anticoagulation with warfarin for a mechanical heart valve
Persons who require chronic oral anticoagulation with warfarin for a ventricular assist device
Persons who require chronic oral anticoagulation with warfarin for chronic atrial fibrillation
Persons who require chronic oral anticoagulation with warfarin for deep venous thrombosis

3 Active Policies

ANTHEM-CG-DME-30, Prothrombin Time Self-Monitoring Devices

A55754, Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding

AETNA-CPB-0173, Prothrombin Time (INR) Home Testing Devices

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G0249, Provision of test materials and equipment for home inr monitoring of patient