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Prothrombin Tests Win Coverage Battle, But Payment Hurdles Remain

This article was originally published in The Gray Sheet

Executive Summary

CMS' Sept. 18 coverage decision for prothrombin time self-testing will provide Medicare reimbursement for the disposable test strips, but not the home-use monitoring equipment, according to the Centers for Medicare & Medicaid Services.

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Payment instructions to local Medicare contractors have been issued, arriving eight months after CMS' coverage decision in September 2001 (1"The Gray Sheet" Oct. 1, 2001, p. 3) and will become effective July 1. Payment levels for procedure code G0249, covering "test materials and equipment," will be released in the July update of the Medicare physician fee schedule...

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