Meet G0249-G0250 Requirements to Prevent Delays

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In CMS
May 31, 2011
14 Comments
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You may know which code accurately describes a physician’s services for test materials and equipment for home international normalized ratio (INR) monitoring and review, but you’ll need more than just the right code to get paid for such services. Jurisdiction 1-Medicare administrative contractor (J1-MAC) Palmetto GBA recently published a provider education article on its website addressing the correct billing, service, and documentation requirements for HCPCS Level II codes G0249 and G0250.

G0249- Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include four tests.

G0250- Physician review, interpretation, and patient management of home INR testing for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units of service include four tests.

Code G0249 requires not only the provision of test materials and equipment to eligible beneficiaries, but also the reporting of test results to the physician. To meet the service requirement, testing is limited to once per week, and G0249 requires that four tests be performed and results reported to the physician. Health records lacking information regarding when and how the physician was notified would not meet the service requirement necessary to submit G0249.

Physicians submitting claims for HCPCS Level II code G0250 should record the results of home INR testing and ensure that each of the four test results reviewed are documented.

Adhering to this guidance will promote correct coding and payment and decrease potential delays in reimbursement due to record reviews.

Source: Palmetto GBA

14 Responses to “Meet G0249-G0250 Requirements to Prevent Delays”

  1. […] You may know which code accurately describes a physician’s services for test materials and equipment for home international normalized ratio (INR) monitoring and review, but you’ll need more than just the right code to get paid for such services. Jurisdiction 1-Medicare administrative contractor (J1-MAC) Palmetto GBA recently published a provider education article on its website… Read more » […]

  2. Margaret Willingham says:

    Are there odes for this service done on outpatient basis, eg., done in the lab at a hospital?????

  3. Margaret Willingham says:

    Are there codes for this service done on outpatient basis, eg., done in the lab at a hospital?????

  4. Tobin says:

    G0250 denied by Medicare ” Not Deemed Medcially necessary . Please suggest if the code requires diagnosis correction or needs documention .

    Thanks
    Tobin

  5. Karla says:

    what was your diagnosis code? How many units of service did you bill?

  6. Holly says:

    TrailBlazer only mentions that G0250 be paid for pulmonary embolism and atrial fibrillation dx. We got denied when we used ‘need for long term anticoagulation therapy’, but got paid when we changed to PE.

  7. Holly says:

    It will also be paid for ‘mechanical heart valve’…

  8. linda mason says:

    can the G0250 be used to bill inr done at the lab?

  9. cindy says:

    billed G0250 along w/99214 G0250 denied -B15 service/procedure requires a qualifying service be received & covered- does a modifier need to be used

  10. debbei says:

    Billing G0250–did you bill 4 unit in one month or bill seprate four times a month?

  11. Amber says:

    Do I bill date range for the month? for example 1-1-13 thru 1-28-13. Do I bill 4 units? Do I list each date the test was done for the month at 1 unit each?

  12. Cyndi says:

    What is the appropriate documentation needed for the interpretation and report in order to bill the G0250?

  13. Michael Laing says:

    As an IDTF, what qualifications does a supervisory physician require to bill Medicare, under the CPT codes G0248 & G0249?

  14. Carrie Zysk says:

    The qualifications for Medicare in order to bill this code are, 1. not more than 4 units in a 28 day period, 1. a training session with a Registered Nurse 3. the patient must be on anticoagulant therapy for at least 90 days 4. the patient must have a DX approved by Medicare.

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