CMS to Expand Coverage for Ambulatory Blood Pressure Monitoring

The Centers for Medicare & Medicaid Services announced a plan to expand coverage for ambulatory blood pressure monitoring (ABPM) in response to a request from stakeholders.

ABPM is a noninvasive diagnostic test used track blood pressure over a 24-hour period removing the possibility for a patients reading be swayed by nervousness in the doctors’ office. By utilizing ABPM, a doctor will be able to more accurately assess a patient’s blood pressure during daily activities and routine living, rather than measure increased pressure when a patient’s heart may be pumping faster or slower due to nerves in the doctor’s office. ABPM could make the difference in making a diagnosis.

“CMS is dedicated to improving cardiovascular health in the Medicare population,” said CMS Administrator Seema Verma in a press release.  “[This] 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 health care. We believe stakeholders will appreciate the policy being expanded to include diagnostic uses recommended by the multi-society task force blood pressure practice guidelines.”

This expansion in coverage comes as a request from stakeholders to reexamine the national coverage determination. Prior to the rule change, ABPM was only covered for patients with suspected white coat hypertension under specific conditions, according to the CMS press release.

“Consistent with multi-society professional guidelines, [CMS’] decision expands access to ABPM to include coverage for cases of suspected ‘masked hypertension,’ which is essentially the opposite of white coat hypertension and occurs when blood pressure measurements in a doctor’s office are lower than measurements taken outside a doctor’s office,” explained CMS in the press release.

The rule also adjusts the low blood pressure threshold for hypertension from the current 140/90 to a reduced 130/80 to better align with society recommendations, opening the opportunity for more patients to qualify for ABPM. —Edan Stanley