CMS extends Medicare coverage for ambulatory blood pressure test

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The Centers for Medicare and Medicaid Services on Tuesday announced a new policy expanding national coverage for ambulatory blood pressure monitoring.

ABPM, a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles, was only previously covered under specific conditions for those patients with suspected white coat hypertension—having higher blood pressure in a doctor’s office than out-of-office BP.

Now, CMS has also extended its policy to beneficiaries with suspected masked hypertension—the opposite of white coat hypertension, which occurs when blood pressure measurements in a doctor’s office are lower than measurements taken outside of the clinical environment.

“ABPM devices provide a larger number of readings than (office blood pressure monitoring) and a profile of blood pressure in the patient’s usual environment,” states the agency’s decision memo, which notes that CMS received a request from stakeholders to reconsider its national coverage determination. “ABPM is intended to allow identification of white coat and masked hypertension, uncover nocturnal hypertension, and assess blood pressure variability over a 24-hour period as well as the 24-hour efficacy of antihypertensive medication.”

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The agency’s decision memo also lowers the blood pressure threshold for hypertension from the current policy of 140/90 down to 130/80 to follow the latest society recommendations regarding the diagnostic criteria, as well as enable more patients to take advantage of the benefits of ABPM.

ABPM devices are “small portable machines connected to a BP cuff worn by patients that record BP at regular intervals over 24 to 48 hours while patients go about their normal activities, including sleep.” As such, CMS contends that they are “an essential tool in managing hypertension to reduced mortality and improve other health outcomes for Medicare beneficiaries.”

The ABPM devices are covered once per year for eligible patients and must be:

  • Capable of producing standardized plots of blood pressure measurements for 24 hours with daytime and night-time windows and normal blood pressure bands demarcated.
  • Provided to patients with oral and written instructions and a test run in the physician’s office must be performed.
  • Interpreted by the treating physician or treating non-physician practitioner.

“CMS is dedicated to improving cardiovascular health in the Medicare population,” said CMS Administrator Seema Verma in a written statement. “Today’s decision reflects CMS’ commitment to continually updating our policies to ensure that more Medicare beneficiaries have access to the latest technology and appropriate evidence-based healthcare. We believe stakeholders will appreciate the policy being expanded to include diagnostic uses recommended by the multi-society task force blood pressure practice guidelines.”

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