NCD 290.2

Item/Service Description

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.

Indications and Limitations of Coverage

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.

Cross Reference

See the Medicare Benefit Policy Manual, Chapter 7