When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10318.pdf. Accessed April 20, 2020.
Centers for Medicare & Medicaid Services (CMS). Decision Memorandum.CAG-00087R: Prothrombin time (INR) monitor for home anticoagulation management. [CMS Web site]. 03/19/2008. Available at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=209&NcaName=Prothrombin+Time+(INR)+Monitor+for+Home+Anticoagulation+Management&NCDId=269&ncdver=2&IsPopup=y&bc=AAAAAAAAEAAA&. Accessed April 20, 2020.
Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD).190.11: Home prothrombin time/International normalized ratio (PT/INR) monitoring for anticoagulation management. [CMS Web site]. 03/19/2008. Available at:https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=269&ncdver=2&bc=AAAAgAAAAAAA&.
Accessed April 20, 2020.
Noridian Healthcare Solutions. Local Coverage Article.A55426. Standard Documentation Requirements for All Claims Submitted to DME MACs . [Noridian Healthcare Solutions Web site]. Original 01/01/2017. Revised 04/06/2020. Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=55426. Accessed April 20, 2020.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Rubicon Prothrombin Time Monitoring System. 510(k) summary. [FDA Web site]. 09/03/2002. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf2/k022922.pdf.
Accessed April 20, 2020.
Policy: 05.00.44k:Repair and Replacement of Durable Medical Equipment (DME)
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: