NCD20.19 AMBULATORY BLOOD PRESSURE MONITORING

 

 

Effective Date of this Version

7/1/2003

 

 

Benefit Category

 

• Diagnostic Tests (other).

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

 

Item/Service Description

 

• Ambulatory blood pressure monitoring (ABPM) involves the use of a non-invasive device which is used to measure blood pressure in 24-hour cycles.

• These 24-hour measurements are stored in the device and are later interpreted by the physician.

 

 

Indications and Limitations of Coverage

 

• ABPM must be performed for at least 24 hours to meet coverage criteria.

• ABPM is only covered for those patients with suspected white coat hypertension.

• Suspected white coat hypertension is defined as

o Office blood pressure >140/90 mm Hg on at least three separate clinic/office visits with two separate measurements made at each visit.

o At least two documented blood pressure measurements taken outside the office which are <140/90 mm Hg.

o No evidence of end-organ damage.

• The information obtained by ABPM is necessary in order to determine the appropriate management of the patient.

• ABPM is NOT covered for any other uses.

o In the rare circumstance that ABPM needs to be performed more than once in a patient, the qualifying criteria described above must be met for each subsequent ABPM test.

o For those patients that undergo ABPM and have an ambulatory blood pressure of <135/85 with no evidence of end-organ damage, it is likely that their cardiovascular risk is similar to that of normotensives.

o They should be followed over time.

o Patients for which ABPM demonstrates a blood pressure of >135/85 may be at increased cardiovascular risk, and a physician may wish to consider antihypertensive therapy.

 

 

Claims Processing Instructions

 

• TN 109 (Medicare Claims Processing)

 

 

Coverage Transmittal Link

 

• http://www.cms.gov/transmittals/downloads/R168CIM.pdf

 

 

National Coverage Analyses (NCAs)

 

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Ambulatory Blood Pressure Monitoring (CAG-00067N) opens in new window

• First reconsideration for Ambulatory Blood Pressure Monitoring (CAG-00067R) opens in new window

 

Medicare NCD Link