CMS Expands Medicare Coverage of Ambulatory Blood Pressure Monitoring

July 2019 ~

CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.

The final decision covers the same key points as the draft released in April but features some changes, such as the removal of a requirement that patients undergo three months of behavioral interventions before ABPM.

According to the CMS Press Release, the agency received a request from stakeholders to reconsider this national coverage determination. Prior to the release of the final policy, ABPM was covered only for those patients with suspected “white coat hypertension” under specific conditions. CMS states that new rule expands access to ABPM to include coverage for cases of suspected “masked hypertension” and will now reimburse physicians for ABPM performed when they suspect blood pressure readings taken from a patient in a clinical setting are artificially low.

Additionally, CMS removed the requirement for ABPM devices to be certified and validated for use in the intended patient population by the dabl Educational Trust or a similar blood pressure monitoring quality control organization. The agency retained other requirements on the choice of ABPM devices.

The final decision also includes an updated definition of suspected masked hypertension. The update states a patient should be diagnosed with the condition when presenting an average office systolic blood pressure between 120 mm Hg and 129 mm Hg or diastolic blood pressure between 75 mm Hg and 79 mm Hg, plus at least two measurements of greater than 130/80 mm Hg taken outside a clinical setting.

The agency states that the decision to expand coverage will lower the blood pressure threshold for hypertension from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria. This will allow more patients to use ABPM and receive appropriate treatment if needed, according to CMS.

Source(s): Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2); CMS Press Release; Medscape; Modern Healthcare; Cardiovascular Business;