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HCPCS G0249 · Level II · G code

G0249: Provide inr test mater/equip, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0249

Medicare payment
$65.80
PFS non-facility, national
Coverage code
D
special coverage instructions apply
Practitioner MUE
3
MAI 3
OPPS status
SI V
Clinic or emergency department visit
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 1

TL;DR

CMS describes HCPCS G0249, added in 2002, as "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". Medicare's October 2026 physician fee schedule pays G0249 $65.80 non-facility and no facility amount facility nationally, from 0.00 work, 1.96 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $66.13 at $33.5675. MUE limits for G0249: practitioner 3 (MAI 3, Nature of Service/Procedure); hospital outpatient 3 (MAI 3, CMS Policy). 1 billing and coding article lists G0249 across 6 states: A55754. HCPCS record: BETOS Y1 (other - Medicare fee schedule); pricing indicator 11; type of service 5 (diagnostic laboratory). Nearby codes: G0248, G0250, G0247, G0246.

G0249 descriptor and code status

The October 2026 HCPCS Level II file describes G0249 as “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”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0249 CPT code", G0249 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0249
FieldValue
Short descriptorProvide inr test mater/equip
Added to HCPCS2002-07-01
Last actionN (no maintenance), effective 2008-03-19
Coverage codeD: special coverage instructions apply
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryY1: other - Medicare fee schedule
Type of service5: diagnostic laboratory

Medicare payment for G0249

Medicare's October 2026 physician fee schedule pays G0249 $65.80 non-facility and no facility amount facility nationally, from 0.00 work, 1.96 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $66.13 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status R: restricted coverage: contractor-priced when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 3 (technical component only).

PFS relative values and national payment for G0249
ComponentNon-facilityFacility
Work RVU0.000.00
Practice expense RVU1.96NA
Malpractice RVU0.010.01
Total RVUs1.97NA
National payment (CF $33.4009)$65.80n/a
Qualifying APM participant (CF $33.5675)$66.13n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: general supervision

Hospital outpatient (OPPS Addendum B)

Status indicator V (Clinic or emergency department visit), APC 5012 (Clinic Visits and Related Services), national unadjusted payment $136.02 with a minimum unadjusted copayment of $27.21.

Medically Unlikely Edits for G0249

MUE limits for G0249: practitioner 3 (MAI 3, Nature of Service/Procedure); hospital outpatient 3 (MAI 3, CMS Policy). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0249 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services33 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital33 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for G0249 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0249 in v323r0.

G0249 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0249 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0249

0 active Local Coverage Determinations and 1 billing and coding article list G0249. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0249
ArticleTitleContractor(s)Related LCD
A55754Billing and Coding: Home PT/INR Monitoring (G0249) Billing and CodingNoridian Healthcare Solutions, LLC—

Denials to expect on G0249

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0249

CARC 151 · N362

units of G0249 exceed the practitioner MUE of 3 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0249 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0249 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0249

What does HCPCS code G0249 describe?

"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"), in the G section (procedures and professional services, temporary). Added 2002-07-01; last action N (no maintenance) effective 2008-03-19.

Is G0249 a CPT code?

No: CMS maintains G0249 in HCPCS Level II, while the AMA maintains CPT. People do search "G0249 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0249?

Medicare's October 2026 physician fee schedule pays G0249 $65.80 non-facility and no facility amount facility nationally, from 0.00 work, 1.96 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $66.13 at $33.5675.

How many units of G0249 can be billed per day?

MUE limits for G0249: practitioner 3 (MAI 3, Nature of Service/Procedure); hospital outpatient 3 (MAI 3, CMS Policy). For the practitioner MUE (MAI 3), units above 3 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0249?

Coverage code D (special coverage instructions apply). 1 billing and coding article lists G0249 across 6 states: A55754.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.