CPT 93793Cardiology

Anticoag mgmt pt warfarin

CPT code 93793 covers the professional service of managing a patient's warfarin (blood thinner) therapy, including reviewing lab results, adjusting dosages, and providing patient education. This is an outpatient management service typically provided monthly for patients on long-term anticoagulation.

Showing rates for

National Average

Base Medicare rate

$11.00

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.18

PE RVU (NF)

0.15

MP RVU

0.01

Total RVU

0.34

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 93793 no more than once per monitoring period (typically 30 days); Medicare considers this a monthly service
Impact: Prevents denials for exceeding frequency limitations; duplicate billing within 30 days results in automatic denial
Document the specific INR value, date of test, warfarin dose adjustment (or confirmation of current dose), and any patient education provided
Impact: Missing INR documentation is the leading cause of audit recoupment; complete documentation prevents 80% of post-payment denials
Do not bill 93793 on the same day as an E/M visit unless modifier 25 is appended and the E/M addresses a separate, significant problem
Impact: Without proper modifier use, the $11 for 93793 will bundle into E/M; modifier 25 preserves both payments
Ensure service is not duplicated with chronic care management (CCM) codes 99490, 99439, or care coordination codes that may include medication management
Impact: Overlapping services cause denials; if patient receives CCM, warfarin management should be documented as separate service or included in CCM time
Verify patient had an INR test during the monitoring period; some payers require the INR to be obtained within specific timeframes (typically 7-14 days)
Impact: No INR test = automatic denial; ensure lab orders and results are in medical record before billing
Consider whether pharmacy-managed anticoagulation services under collaborative agreement qualify for billing under physician NPI with appropriate state regulations
Impact: Expands service capacity without adding physician time; pharmacist-managed protocols can maintain the $11 per patient monthly revenue

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Frequently asked questions

How much does Medicare pay for CPT code 93793 in 2025?

Medicare pays $11 for CPT 93793 in 2025 under both the facility and non-facility rates (national average). The code has 0.34 total RVUs with a conversion factor of 32.3465.

Can CPT 93793 be billed with an office visit on the same day?

Yes, but only if the office visit addresses a separate and significant problem from the anticoagulation management. You must append modifier 25 to the E/M code and clearly document both services separately in the medical record to avoid bundling.

How often can you bill CPT 93793 for warfarin management?

CPT 93793 should be billed once per monitoring period, typically every 30 days. Medicare considers this a monthly service, and billing more frequently will result in denials for exceeding frequency limitations unless exceptional circumstances are documented.

What documentation is required to bill CPT 93793?

You must document the INR test date and value, current warfarin dose, clinical assessment of the INR, any dose adjustments made or rationale for continuing current dose, patient contact and education, and the plan for next INR test. Missing any of these elements increases audit risk.

Can pharmacists bill CPT 93793 for anticoagulation management?

Pharmacists can provide the clinical service under collaborative practice agreements or protocols, but billing must occur under the supervising physician or qualified non-physician practitioner's NPI. Direct pharmacist billing under their own NPI is generally not reimbursed by Medicare for 93793.

Is CPT 93793 covered for patients on newer anticoagulants like apixaban or rivaroxaban?

No, CPT 93793 is specifically for warfarin anticoagulation management that requires INR monitoring. Direct oral anticoagulants (DOACs) like apixaban, rivaroxaban, or dabigatran do not require INR monitoring and should not be billed with 93793; use appropriate E/M codes for their management instead.

Can CPT 93793 be billed with chronic care management codes?

Generally no, because both services involve medication management and care coordination. If a patient receives chronic care management (CCM) services under codes 99490 or 99439, the warfarin management time should be included in the CCM time rather than billed separately as 93793 to avoid duplication of services.