Subject to the terms and conditions of the applicable Evidence of Coverage, prothrombin time monitoring is covered under the medical benefits of the Company’s Medicare Advantage products when the medical necessity criteria listed in this medical policy are met.
However, services that are identified in this policy as not medically necessary are not eligible for coverage or reimbursement by the Company.
This policy has been identified for the ICD-10 CM code update, effective 10/01/2019.
The following ICD-10 CM codes have been added to this policy:
I26.93, I26.94, I48.11, I48.19, I48.20, I48.21, I80.241, I80.242, I80.243, I80.249, I80.251, I80.252, I80.253, I80.259, I82.451, I82.452, I82.453, I82.459, I82.461, I82.462, I82.469, I82.551, I82.552, I82.553, I82.559, I82.561, I82.562, I82.563, I82.569.
The following ICD-10 CM codes have been deleted from this policy:
I48.1 and I48.2.
The following CPT codes have been added to this policy:
FROM: Embolism and thrombosis of superficial veins of left lower extremities
TO: Embolism and thrombosis of superficial veins of left lower extremity