These are covered services when the provider bills a "medically necessary" diagnosis code with supporting documentation and the following criteria are met.
Medicare National Coverage Determinations Manual
Chapter 1, Part 3, Section 190.11
"For services furnished on or after March 19, 2008, Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin. The monitor and the home testing must be prescribed by a treating physician and all of the following requirements must be met:
1. The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,
2. 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,
3. 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,
4. Self-testing with the device should not occur more frequently than once a week."
Reference:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part3.pdf
Additional Information:
https://www.adldata.org/wp-content/...ek-Medical-Reimbursement-Handbook-for-HCP.pdf
The blood test is billed with a clinical laboratory procedure code so the following rule applies.
Medicare Claims Processing Manual
Chapter 16, Section 30.2
Deductible and Coinsurance Application for Laboratory Tests
Neither the annual deductible nor the 20 percent coinsurance apply to:
• Clinical laboratory tests performed by a physician, laboratory, or other entity paid on an assigned basis.
Reference:
https://www.cms.gov/manuals/downloads/clm104C16.pdf