Good news! The Center for Medicare and Medicaid Services (CMS) is expanding its coverage of INR home monitoring to include patients on warfarin for DVT (deep vein thrombosis) and PE (pulmonary embolism), i.e., VTE (venous thromboembolism, blood clots in the legs and arms). Previously, CMS provided coverage only for home INR testing of patients with mechanical heart valves.
“This is good news,” says Dr. Stephan Moll, chair of NBCA’s Medical and Scientific Advisory Board. “However, in my opinion, as long as reimbursement (for the services healthcare workers provide to INR home testers) or the service-delivery structures do not change, I am doubtful that INR home testing will fully take off. This is very unfortunate, as INR home testing is really the way to go for many patients on warfarin. Under the present circumstances, doctors have relatively little incentive to support their patients doing self testing.”
The CMS Decision Summary is as follows:
“After examining additional medical evidence, we are expanding Medicare coverage of home prothrombin (INR) monitoring to include chronic atrial fibrillation and venous thromboembolism under the following conditions:
- The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism; and
- the beneficiary has been anticoagulated for at least three months prior to use of the home INR device; and
- the beneficiary has undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home, and
- home-testing with the device occurs no more frequently than once a week.”