Blue Cross & Blue Shield of MississippiAll Plans · Billing Codes · Medical Policy · Cardiology, HematologyMedium impact
Home Prothrombin Time Monitoring
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
At-home prothrombin time (INR) monitoring of chronic warfarin therapy may be considered medically necessary for patients who require continuous anticoagulation for chronic medical conditions, including patients with mechanical heart valves and chronic atrial fibrillation. Before at-home monitoring starts, patients must have undergone anticoagulation management for at least 3 months. The policy history records a 05/04/2026 update that removed ICD-9 diagnosis codes from the Code Reference section and added ICD-10 diagnosis codes Z95.811, Z95.812 and Z95.818. The covered procedure codes are CPT 93792 and HCPCS E1399, G0248, G0249 and G0250.
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01Billing team: Before at-home INR monitoring starts, document that the patient has undergone anticoagulation management for at least 3 months, because at-home monitoring is medically necessary only when this requirement is met.
02Providers: Document that the patient needs continuous anticoagulation for a chronic condition such as a mechanical heart valve or chronic atrial fibrillation, since a prescription or order does not in itself establish medical necessity.
03Billing team: Bill CPT 93792 and HCPCS E1399, G0248, G0249 and G0250 only for services performed according to the Policy section, and for G0248 through G0250 only for patients who meet Medicare coverage criteria.
04No payment is made for services that are not documented to be medically necessary.
Codes mentioned
93792E1399G0248G0249G0250Z95.811Z95.812Z95.818
Original notice
Home Prothrombin Time Monitoring
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