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CINDY Posted Thu 01st of February, 2018 12:08:58 PM
Does 93793 replace G0250 or can both be billed together and is 93793 to be used when we call patients with other lab results?
SuperCoder Answered Fri 02nd of February, 2018 02:10:02 AM




Here is some information about CPT code 93793 :

93793 is payment for managing patients taking warfarin. It includes the review and interpretation of a new lab test done in the home, office or lab. This code does have work RVUs, recognizing that it is physician/NP/PA work to interpret the lab results, make a dosing adjustment if needed, and schedule additional tests, again if needed.  The dosage does not need to be changed in order to report 93793.  It is for a new test result.

Medicare will cover the use of home PT / INR monitoring for chronic, oral anticoagulation management for patients on warfarin with: Mechanical heart valves, Chronic atrial fibrillation,Venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism).The monitor and the home testing must be prescribed by a treating physician meet all of the following requirements:

The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,

The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,

The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,

Self-testing with the device should not occur more frequently than once a week.


Medicare coverage criteria:

Includes provision of materials for use in the home

Reporting of test results to physician

Not occurring more frequently than once a week

Includes materials for 4 tests

Therefore, the patient is self-testing once a week for 4 weeks (7 days / week x 4 = 28 days) and reports results to their physician. Once the patient has completed their testing, occurring no more frequently than once a week, the physician reviews and interprets the results of those 4 tests.

The physician's service is billed with procedure code G0250, no more frequently than once every 4 weeks or every 28 days (7 days / week x 4 = 28 days). There must be 28 days between each submission of G0250.

For further information consider the following link :

Hope this helps!


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