The Centers for Medicare and Medicaid Services (CMS) has published a final national coverage determination (NCD) expanding coverage for ambulatory blood pressure monitoring (ABPM) to include suspected masked hypertension.

This change is consistent with the 2017 ACC/American Heart Association high blood pressure guideline.

The ACC previously submitted comments to CMS generally supporting the proposed expansion of coverage for ABPM, but also urging the agency to make refinements.

Several of these recommended revisions were included in the final version, including changes to specific BP thresholds for coverage to be consistent with the guideline, and removal of a requirement for three months of behavioral interventions that could have obstructed access to care.

The final NCD also includes a requirement for two measurements taken outside the office as well as criteria for ABPM devices.

CMS Administrator Seema Verma, highlighted the incorporation of guideline recommendations in a press release, stating: "We believe stakeholders will appreciate the policy being expanded to include diagnostic uses recommended by the multi-society task force blood pressure practice guidelines."

The updated coverage is effective immediately; however, Medicare Administrative Contractors (MAC) will not update their claims processing software for several months. Members should contact a provider representative or medical director if questions or difficulties with claims arise in the interim period.

Keywords: ACC Publications, Cardiology Magazine, Health Policy, Blood Pressure Monitoring, Ambulatory, Masked Hypertension, Blood Pressure, Centers for Medicare and Medicaid Services, U.S., American Heart Association, Physician Executives, Medicaid, Medicare, Hypertension, Blood Pressure Determination, Software

< Back to Listings