CMS Home Health Nurses' Visits to Patients Requiring Heparin Injection Form


Home Health Nurses' Visits for Heparin Injection

Indications

(93778) Is the heparin injection prescribed by a physician for a condition that includes recurrent deep venous thrombosis, recurrent pulmonary emboli, or requires long term anticoagulation? 
(93779) Is the patient homebound? 
(93780) Is the patient pregnant and requires anticoagulant therapy? 
(93781) Has the patient shown sensitivity to warfarin necessitating substitution with heparin? 
(93782) Has the physician documented that the patient cannot tolerate warfarin? 

Contraindications

(93783) Can the patient or the caring person self-administer the subcutaneous injections of low dose heparin? 
(93784) Is the request for home health nurse visits beyond the initial 6-month period without justification and documentation of need by the prescribing physician (except for pregnant patients)? 
Effective Date

01/01/2066

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

Professional medical advice indicates that subcutaneous injections of low dose heparin can be, under certain circumstances, medically accepted therapy for the treatment of recurrent deep venous thrombosis, recurrent pulmonary emboli, and other conditions requiring long term anticoagulation. The usual drug of choice for these conditions is warfarin. Heparin may be substituted for warfarin in circumstances such as demonstrated warfarin sensitivity. Heparin is now the drug of choice for anticoagulation during pregnancy.

Medicare payment may be made for several visits by the home health nurse to teach the patient or the caring person to give subcutaneous injections of low dose heparin if it is prescribed by a physician for a homebound patient who:

  • Is pregnant and requires anticoagulant therapy, or
  • Requires treatment for deep venous thrombosis or pulmonary emboli or for another condition requiring anticoagulation and documentation justifies that the patient cannot tolerate warfarin.

If the patient or caring person is unable to administer the injection, nursing visits to give the injections on a daily basis, 7 days a week, for a period of up to 6 months (in the case of pregnancy, visits may be made for a period beyond 6 months if reasonable and necessary) would be reimbursed by Medicare. Coverage for these services after 6 months of treatment would be provided only if the prescribing physician can justify and document the need for such an extended course of treatment. Documentation of need for heparin injections beyond 6 months would not be required for pregnant patients who meet the homebound criteria.