G0249 HCPCS code: Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0249 is the HCPCS Level II code for provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests. In 2024 Medicare paid an average of $62.83 per service for G0249 across 787,536 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 3 per day on outpatient hospital claims. Medicare volume fell 19% from 2022 to 2024 (967,179 to 787,536 services). In 2024, about 571 clinicians billed Medicare for G0249 for 106,275 beneficiaries; California, Connecticut, New York accounted for 97% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | Y1 |
| Added | 2002-07-01 |
| Last action effective | 2008-03-19 |
Who bills G0249 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 571 |
| Medicare beneficiaries | 106,275 |
| States with claims | 17 |
| Share of services in top 3 states (California, Connecticut, New York) | 97% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0249, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 967,179 | 135,380 | $62.37 | $46.29 |
| 2023 | 891,931 | 120,208 | $89.42 | $65.47 |
| 2024 | 787,536 | 106,275 | $87.72 | $62.83 |
States with the most G0249 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 674,246 | $65.16 |
| Connecticut | 44,961 | $49.65 |
| New York | 43,636 | $50.49 |
| Michigan | 7,776 | $46.16 |
| Iowa | 7,036 | $41.59 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 3 | CMS Policy |
| practitioner claims | 3 | Nature of Service/Procedure |
Medicare policy articles for this code
- A55754: Billing and Coding: Home PT/INR Monitoring (G0249) Billing and Coding (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
What changed for G0249
- 2002-07-01: G0249 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0249?
G0249 is the HCPCS Level II code for provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests. Short descriptor: "Provide inr test mater/equip".
How much does Medicare pay for G0249?
In 2024, the average Medicare payment was $62.83 per service (average allowed $87.72).
Does Medicare cover G0249?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of G0249 can be billed per day?
3 on outpatient hospital claims; 3 on practitioner claims (NCCI medically unlikely edits).
Related G02 codes
- G0202 — Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
- G0204 — Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
- G0206 — Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
- G0219 — Pet imaging whole body; melanoma for non-covered indications
- G0235 — Pet imaging, any site, not otherwise specified
- G0237 — Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
- G0238 — Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
- G0239 — Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
- G0245 — Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
- G0246 — Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
- G0247 — Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
- G0248 — Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
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Next steps
- Run a reimbursement report for a device billed under G0249
- Watch G0249 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0249
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.