Centers for Medicare & Medicaid Services

Content Section

Publication Number

100-3

Manual Section Number

20.19

Version Number

Effective Date of this Version

7/1/2003

Implementation Date

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

Office blood pressure >140/90 mm Hg on at least three separate clinic/office visits with two separate measurements made at each visit;
At least two documented blood pressure measurements taken outside the office which are <140/90 mm Hg; and
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. 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.

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. They should be followed over time. 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.

Transmittal Number

168

Transmittal Link

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

Revision History

12/2001 - Changed status from non-covered to covered and clarified conditions under which ABPM is covered. Effective and implementation dates 04/01/2002. (TN 149) (CR 1985)

03/2003 - Specified physician is required to perform interpretation of data obtained through ABPM, but no requirements regarding setting where interpretation performed. Effective and implementation dates 07/01/2003. (TN 168) (CR 2625)

Claims Processing Instructions

TN 109 (Medicare Claims Processing)

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.