CMS Ambulatory Blood Pressure Monitoring Form


Effective Date

07/02/2019

Last Reviewed

NA

Original Document

  Reference



Background for this Policy


A. General

Ambulatory Blood Pressure Monitoring (ABPM) is a diagnostic test that allows for the identification of various types of high blood pressure (BP). ABPM devices are small portable machines that are connected to a blood pressure cuff worn by patients that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities, including sleep. The recording is interpreted by a physician or non-physician practitioner, and appropriate action is taken based on the findings. Diagnosis and treatment of high BP is important for the management of various conditions including cardiovascular disease and kidney disease.


B. Nationally Covered Indications

For dates of service on and after July 2, 2019, the Centers for Medicare & Medicaid Services (CMS) believes that the evidence is sufficient to determine that ABPM is reasonable and necessary for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:

  1. For beneficiaries with suspected white coat hypertension, which is defined as average office BP of systolic BP > 130 mm Hg but < 160 mm Hg, or diastolic BP > 80 mm Hg but < 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit, and with at least two BP measurements taken outside the office which are < 130/80 mm Hg.
  2. For beneficiaries with suspected masked hypertension, which is defined as average office BP between 120 mm Hg and 129 mm Hg for systolic BP, or between 75 mm HG and 79 mm Hg for diastolic BP on two separate clinic/office visits with at least two separate measurements made at each visit, and at least two BP measurements taken outside the office which are ≥ 130/80 mm Hg.

ABPM devices must be:

  • capable of producing standardized plots of BP measurements for 24 hours with daytime and night-time windows and normal BP bands demarcated; and,
  • provided to patients with oral and written instructions and a test run in the physician’s office must be performed; and,
  • interpreted by the treating physician or treating non-physician practitioner.

For eligible patients, ABPM is covered once per year.

C. Nationally Non-Covered Indications

N/A

D. Other

Coverage of other indications for ABPM not indicated above are at the discretion of the Medicare Administrative Contractors.
(Last reviewed July 2019.)


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