Coverage Requirements

60.1 – Coverage Requirements (Rev. 1562, Issued: 07-25-08, Effective: 03-19-08, Implementation: 08-25-08) 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.