In the human body, factor V is a protein that is necessary for proper blood clotting. Some people have a genetic mutation of the protein which is called factor V Leiden. This is a disorder that can cause a condition known as thrombophilia.

If you have the factor V Leiden mutation, you are at greater risk of developing blood clots. This abnormal clotting most commonly occurs in either the deep veins of the legs (deep vein thrombosis), or in the lungs (pulmonary embolism). Not everyone who has factor V Leiden experiences abnormal clotting, but there is a higher risk for those that do.

Because deep vein thrombosis and pulmonary embolism are serious enough to be life threatening, if you suspect that you have the genetic mutation of factor V, factor V Leiden, you should be tested to determine your risk factor for thrombophilia. Because factor V Leiden is a hereditary condition, you may have an increased chance of having it if you have a relative with factor V Leiden. It is also more common for Caucasians of European descent to have this factor V mutation.

In order to find out if you have factor V Leiden, a screening can be done by taking a sample of your blood to test for activated protein C resistance. A positive result may mean that you have the factor V Leiden mutation. If you or your health care provider suspect that you may be at a higher risk for factor V Leiden, you may need more information about whether your Medicare benefits cover testing.

Symptoms of Thrombophilia Caused by Factor V Leiden

If you have a mutation in your F5 gene, this causes factor V Leiden thrombophilia. It does not affect everyone who has the mutation, but it can cause problems with your blood’s coagulation factor V.

Because thrombophilia most commonly causes abnormal blood clots in the legs and lungs, it is important to know some of the signals that indicated these conditions.

For deep vein thrombosis, the signs may include:

• Pain in the effected leg
• Swelling
• Redness and/or skin warmth

If a clot has moved into the lungs, you may have the following symptoms:

• Severe shortness of breath that comes on suddenly
• Chest pain that occurs when drawing in breath
• Coughing that produces blood
• Rapid heartbeat

Statistics indicate that factor V Leiden is the most common inherited form of thrombophilia in the United States and Europe among Caucasians. Fortunately, Medicare recipients have coverage for the necessary blood test needed to screen for this condition.

 Medicare Coverage for Factor V Leiden Testing

Under both Original Medicare Parts A and B, your Medicare benefits offer coverage for blood tests that your health care provider orders to diagnose or monitor a condition or a disease. These blood tests must be medically necessary for Medicare recipients to receive coverage.

If you are enrolled in a Medicare Advantage plan, you have the same coverage that you would have through Original Medicare Parts A and B, but many plans provide additional coverage for blood exams in many cases. Part A (hospital insurance) covers the cost of your Factor V Leiden screening test if your physician deems it medically necessary and orders it while you are being cared for as an inpatient or in a skilled nursing facility. Part B (medical insurance) covers 100 percent of the cost of a medically necessary blood test if your health care provider orders it as part of your outpatient care in a medical clinic or doctor’s office setting. The blood test must be Medicare-approved and the laboratory performing the test must accept Medicare assignment.

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