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  • Insurance Data Form - Coaguchek Patient Services

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PHYSICIAN FIRST NAME. PHYSICIAN LAST NAME. PHONE #. FAX #. PRACTICE/CLINIC NAME. ADDRESS. CITY. STATE. ZIP/POSTAL CODE. INSURANCE .

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This is a CLIA waived system. The CoaguChek XS System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of therapy. The CoaguChek XS System uses fresh capillary or nonanticoagulated venous whole blood.

If the blood draw is performed in the physician's office and processed in their in-office lab, can the 85610 (Prothrombin time) path/lab test be coded, as well as the 93793 code? Yes. Both codes may be reported.

†Patient self-testing services are typically covered by Medicare and most insurance providers Actual coverage, reimbursement and out-of-pocket costs depend on a number of factors and vary by plan. *You may also send this form to your regional office. Please refer to the CoaguChek Patient Services Regional Offices map.

The PT/INR test performed with the CoaguChek XS System for Professional Use by CLIA-waived and non-waived laboratories is billed under CPT code 85610 with or without the QW modifier, as explained below.

93792 is the code used for patients who test their INR at home, rather than going to the laboratory. Prior to starting this home testing, the patient needs to understand how do use the test reliably.

Coaguchek Xs System is a non-prescription medical device, so it is not covered as a prescription drug.

93793 Is payment for managing patients taking . It includes the review and interpretation of a new lab test done in the home, office or lab.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232