Commercial
Advanced Search

Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
07.02.09i

Policy

AMBULATORY BLOOD PRESSURE MONITORING

MEDICALLY NECESSARY
Ambulatory blood pressure monitoring (ABPM) for a 24-hour period or longer is considered medically necessary and, therefore, covered for any of the following indications when there is an absence of hypertensive end-organ damage on physical examination and appropriate laboratory testing:
  • Suspected white coat hypertension demonstrated by the following:
    • The individual has persistently raised blood pressure greater than 130/80 mm Hg on at least three clinic/office visits, with two separate measurements made at each visit, and blood pressure less than 130/80 mm Hg documented on at least two separate blood pressure measurements taken outside the office.
  • Suspected episodic hypertension (e.g., pheochromocytoma that may precipitate hypertension)
  • Hypertension that is resistant or refractory to medications
  • Hypotensive symptoms thought to be related to taking antihypertensive medications
  • Autonomic dysfunction (e.g., sympathetic autonomic nervous system)
  • Suspected masked hypertension (i.e., office blood pressure is normal, but blood pressure during regular activities is elevated)
    • There is a documented clinical suspicion of hypertension (e.g., individuals with left ventricular hypertrophy) but normal or prehypertensive causal measurements
  • In accordance with the American Heart Association, for children and adolescents, monitoring blood pressure patterns in chronic diseases associated with hypertension (e.g., chronic kidney disease, diabetes) 
NOT MEDICALLY NECESSARY
All other uses for ABPM are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the diagnosis of illness or injury.

HOME BLOOD PRESSURE MONITORING DEVICES

Home blood pressure monitoring (HBPM) devices are benefit contract exclusions except for the following conditions:
  • End-stage renal disease in individuals who are receiving home dialysis
  • Pregnancy-induced hypertension
  • Hypertension complicated by pregnancy
  • As required based on Affordable Care Act (ACA) preventive mandates
All other uses for HBPM devices are benefit contract exclusions and, therefore, not eligible for reimbursement consideration.

Individual member benefits must be verified.

AMBULATORY BLOOD PRESSURE MONITORING AND HOME BLOOD PRESSURE MONITORING DEVICES FOR SCREENING

For medical necessity criteria on ABPM or HBPM devices as a screening service, refer to medical policy 00.06.02 (Preventive Care Services).

REPLACEMENT OF HOME BLOOD PRESSURE MONITORING DEVICES

The Company may determine the reasonable useful lifetime of a specific HBPM device based on the manufacturer's recommendation.

In the absence of manufacturer's recommendations, the Company may determine the reasonable useful lifetime of a HBPM device, but it is generally not less than 5 years. Replacement of one or more of its components (parts) that are necessary for its proper functioning due to misuse, abuse, or failure to adequately maintain or care for the item is excluded from coverage.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

PRESCRIPTION (ORDER) REQUIREMENTS
Before submitting a claim to the Company, the supplier must have on file a timely, appropriate, and complete order for each item billed that is signed and dated by the professional provider who is treating the member. Requesting a provider to sign a retrospective order at the time of an audit or after an audit for submission as an original order, reorder, or updated order will not satisfy the requirement to maintain a timely professional provider order on file.

PROOF OF DELIVERY
Medical record documentation must include a contemporaneously prepared delivery confirmation or member’s receipt of supplies and equipment. The medical record documentation must include a copy of delivery confirmation if delivered by a commercial carrier and a signed copy of delivery confirmation by member/caregiver if delivered by the durable medical equipment (DME) supplier/provider. All documentation is to be prepared contemporaneous with delivery and be available to the Company upon request.

CONSUMABLE SUPPLIES
The DME supplier must monitor the quantity of accessories and supplies an individual is actually using. Contacting the individual regarding replenishment of supplies should not be done earlier than approximately 7 days prior to the delivery/shipping date. Dated documentation of this contact with the individual is required in the individual’s medical record. Delivery of the supplies should not be done earlier than approximately 5 days before the individual would exhaust their on-hand supply.

If required documentation is not available on file to support a claim at the time of an audit or record request, the DME supplier may be required to reimburse the Company for overpayments.

Guidelines

In the circumstance that ambulatory blood pressure monitoring (ABPM) needs to be performed more than once on an individual, the qualifying criteria as described in the policy must be met for each subsequent ABPM test.

ABPM IN CHILDREN AND ADOLESCENTS

Conducting ABPM requires specific equipment (that has been validated according to Association for the Advancement of Medical Instrumentation). ABPM in children and adolescents should be used by experts in the field of pediatric hypertension who are experienced in its use and interpretation based on gender-, age-, and height-specific ABPM normative data.

American Heart Association Revised Classification for Ambulatory Blood Pressure in Children and Adolescents (2022)​

ClassificationClinic Systolic or Diastolic Blood Pressure​Mean Ambulatory Systolic or Diastolic Blood Pressure​
Category<13 y of age≥13 y of age<13 y of age≥13 y of age
Normal BP<95th percentile<130/80 mm Hg
<95th percentile OR adolescent cut points​ ​		<125/75 mm Hg over 24-h AND <130/80 mm Hg while awake AND <110/65 mm Hg while asleep ​
White coat hypertension≥95th percentile≥130/80
Masked hypertension<95th percentile<130/80
≥95th percentile OR adolescent cut points ​
≥125/75 mm Hg over 24-h OR ≥130/80 mm Hg while awake OR ≥110/65 mm Hg while asleep ​
Ambulatory hypertension≥95th percentile≥130/80

 

BENEFIT APPLICATION


Subject to the terms and conditions of the applicable benefit contract, ABPM is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

Subject to the terms and conditions of the applicable benefit contract, home blood pressure monitoring (HBPM) devices are covered under the medical benefits of the Company's products.

US FOOD AND DRUG ADMINISTRATION (FDA)

The FDA has approved several ABPM and considers these devices to be Class II devices, which are exempt from premarket notification procedures.

Description

AMBULATORY BLOOD PRESSURE MONITORING (24-HOUR SPHYGMOMANOMETER)

Ambulatory blood pressure monitoring (ABPM) involves the use of a noninvasive device that measures blood pressure in 24-hour cycles (24-hour sphygmomanometer). The device consists of a portable sphygmomanometer attached to a recording device. The ABPM device is fitted to and removed from the individual by a trained technician. The sphygmomanometer inflates at predetermined times, generally every 30 minutes, and the blood pressure recorded at each inflation is stored. The individual performs normal activities while wearing the monitor. The device provides information about blood pressure during daily activities, as well as during sleep.

Automated ABPM is considered more accurate than individual self-monitoring. Therefore, it is generally thought that readings obtained at frequent intervals throughout the day and night would help the professional provider better manage the individual's care. These stored, 24-hour measurements are later interpreted at the professional provider’s office. A clinician is required to interpret the collected data by uploading it onto a computer where device-specific programs are used to categorize and analyze the measurements.

The information that ABPM provides, for example, can help a professional provider determine whether an individual is truly hypertensive or is exhibiting white coat hypertension (WCH). WCH is a condition characterized by persistently raised blood pressure in the doctor's office with a normal ambulatory blood pressure. WCH is defined as blood pressure greater than 130/80 mm Hg on at least three clinic/office visits, with two separate measurements made at each visit, and blood pressure less than 130/80 mm Hg documented on at least two separate blood pressure measurements taken outside the office.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) noted that, in addition to assisting with the evaluation of WCH, ABPM is also helpful with the assessment of apparent antihypertensive drug resistance, hypotensive symptoms while on antihypertensive medications, episodic hypertension, autonomic dysfunction, and masked hypertension.

The American Heart Association states that ABPM is a useful tool in evaluating blood pressure in children and adolescents for similar indications as in adults, including use in children and adolescents with elevated office blood pressure to distinguish true hypertension from WCH. ABPM levels for children and adolescents should be interpreted using appropriate pediatric normative values, which use gender- and height-specific values derived from large pediatric populations. According to the American Academy of Pediatrics, conducting ABPM requires specific equipment and trained staff. Therefore, ABPM in children and adolescents should be performed by experts in the field of pediatric hypertension who are experienced in its use and interpretation.

HOME BLOOD PRESSURE MONITORING DEVICES

The two main types of home blood pressure monitoring (HBPM) devices are nonautomatic and automatic (or electronic). Many of these devices are available for retail purchase, and some have undergone technical validation according to recommended protocols.

SCREENING SERVICES FOR HIGH BLOOD PRESSURE

The US Preventive Services Task Force (USPSTF) (2021​) reaffirmed its prior 2015 recommendation for screening for high blood pressure in adults.  ​

References

Agarwal R, Andersen MJ. Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease. Kidney Int. 2006;69(7):1175-1180.

Agarwal R, Bills JE, Hecht TJ, Light RP. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis. Hypertension. 2011;57(1):29-38.

Andersen MJ, Khawandi W, Agarwal R. Home blood pressure monitoring in CKD. Am J Kidney Dis. 2005; (6):994-1001.

Asayama K, Ohkubo T, Kikuya M, et al. Prediction of stroke by self-measurement of blood pressure at home versus casual screening blood pressure measurement in relation to the Joint National Committee 7 classification: the Ohasama study. Stroke. 2004;35(10):2356-2361.

Asmar R, Zanchetti A. Guidelines for the use of self-blood pressure monitoring: a summary report of the First International Consensus Conference. Groupe Evaluation & Measure of the French Society of Hypertension. J Hypertens. 2000;18(5):493-508.

Beevers G, Lip GY, O'Brien E. ABC of hypertension: Blood pressure measurement. Part II—conventional sphygmomanometry: technique of auscultatory blood pressure measurement. BMJ. 2001;322(7293):1043-1047.

Björklund K, Lind L, Zethelius B, et al. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107(9):1297-1302.

Bobrie G, Chatellier G, Genes N, et al. Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291(11):1342-1349.

Boggia J, Li Y, Thijs L, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007;370(9594):1219-1229.

Ben-Dov IZ, Kark JD, Ben-Ishay D, et al. Predictors of all-cause mortality in clinical ambulatory monitoring: unique aspects of blood pressure during sleep. Hypertension. 2007;49(6):1235-1241.

Bosworth HB, Olsen MK, Grubber JM, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med. 2009(10):687-695.

Campbell NR, Culleton BW, McKay DW. Misclassification of blood pressure by usual measurement in ambulatory physician practices. Am J Hypertens. 2005;18(12 Pt 1):1522-1527.

Cappuccio FP, Kerry SM, Forbes L, et al. Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ. 2004;329(7458):145.

Centers for Medicare & Medicaid Services (CMS). Decision memo for ambulatory blood pressure monitoring (ABPM) (CAG-00067R2). 07/02/2019. Available at:https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=294. Accessed on February 05, 2024.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 20.19: Ambulatory blood pressure monitoring. [CMS Web site]. 07/02/2019. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=254&ncdver=3&bc=AgAAgAAAAQAA&. Accessed February 05, 2024.


Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348(24):2407-15.

Cohen J, Townsend RR. White coat and masked hypertension. 07/11/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 05, 2024.

Company Benefit Contracts.

Davidson MB, Hix JK, Vidt DG, et al. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006;166(8):846-852.

Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-161.

Duncombe SL, Voss C, Harris KC. Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens. 2017; 35(2):213-224.

Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25(11):2193-2198.

Falkner B. Recent clinical and translational advances in pediatric hypertension. Hypertension. 2015;65(5):926-931.

Fan HQ, Li Y, Thijs L, et al. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28(10):2036-2045.

Flynn JT. Ambulatory blood pressure monitoring in children. 07/23/2021. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 05, 2024. 

Flynn JT, Daniels SR, Hayman LL, et al. Ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension. 2014;63(5):1116-35. Available at: Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association | Hypertension (ahajournals.org). Accessed February 05, 2024.


Flynn JT, Urbina EM, Brady TM, et al. Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension. 2022; 79(7): e114-e124. Available at: Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association | Hypertension (ahajournals.org). Accessed February 05, 2024.


Flynn JT, Falkner BE. New clinical practice guideline for the management of high blood pressure in children and adolescents. Hypertension. 2017;70(4)683-686. Available at: New Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents | Hypertension (ahajournals.org). Accessed February 05, 2024.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017; 140(3):e20171904.

Hansen TW, Jeppesen J, Rasmussen S, et al. Ambulatory blood pressure and mortality: a population-based study. Hypertension. 2005;45(4):499-504.

Head GA, Mihailidou AS, Duggan KA, et al. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study. BMJ. 2010;340:c1104.

Hemmelgarn BR, McAllister FA, Myers MG, et al. The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1—blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol. 2005;21(8):645-656.

Hermida RC, Calvo C, Ayala DE, et al. Treatment of non-dipper hypertension with bedtime administration of valsartan. J Hypertens. 2005;23(10):1913-1922.

Ingelsson E, Björklund-Bodegård K, Lind L, et al. Diurnal blood pressure pattern and risk of congestive heart failure. JAMA. 2006;295(24):2859-2866.

International Organization for Standardization. IEC 80601-2-30:2009. Medical electrical equipment—Part 2-30: Particular requirements for basic safety and essential performance of automated noninvasive sphygmomanometers. Geneva: International Organization for Standardization; 2009 (amended 2013). [International Electrotechnical Commission Web site]. 05/01/2013. Preview and full article (for purchase) available at: https://webstore.iec.ch/preview/info_iso81060-2{ed2.0}en.pdf. Accessed February 05, 2024.

James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.

Kario K. Time for focus on morning hypertension: pitfall of current antihypertensive medication. Am J Hypertens. 2005;18(2 Pt 1):149-151.

Kario K, Pickering TG, Umeda Y, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107(10):1401-1406.

Krakoff LR. Cost-effectiveness of ambulatory blood pressure: a reanalysis. Hypertension. 2006;47(1):29-34.

Li Y, Thijs L, Hansen TW, et al. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010;55(4):1040-1048.

Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-1920.

Lurbe E, Redon J, Kesani A, et al. Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med. 2002;347(11):797-805.

Mallion JM, Clerson P, Bobrie G, et al. Predictive factors for masked hypertension within a population of controlled hypertensives. J Hypertens. 2006;24(12):2365-2370.

Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-1087.

Marchiando R, Elston M. Automated ambulatory blood pressure monitoring: clinical utility in the family practice setting. Am Fam Physician. 2003;67(11):2343-2351.

Mattoo TK. Definition and diagnosis of hypertension in children and adolescents. 08/10/2022. Up to Date. [UpToDate Web site]. http://www.uptodate.com/home/index.html. [via subscription only]. Accessed February 05, 2024.

Metoki H, Ohkubo T, Kikuya M, et al. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006;47(2):149-154.

Muxfeldt ES, Bloch KV, Nogueira Ada R, et al. True resistant hypertension: is it possible to be recognized in the office? Am J Hypertens. 2005;18(12 Pt 1):1534-1540.

Muxfeldt ES, Cardoso CR, Salles GF. Prognostic value of nocturnal blood pressure reduction in resistant hypertension. Arch Intern Med. 2009;169(9):874-880.

Myers MG, Godwin M, Dawes M, et al. Measurement of blood pressure in the office: recognizing the problem and proposing the solution. Hypertension. 2010;55(2):195-200.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children, Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-576.

National Institute for Health and Clinical Excellence (NICE). Guidelines. Hypertension in adults: diagnosis and management [NG136]. 2022.(Updated 11/21/2023).  [NICE Web site]. Available at:
Recommendations | Hypertension in adults: diagnosis and management | Guidance | NICE. Accessed February 05, 2024.

National Institutes of Health (NIH): National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. [NIH Web site]. August 2004. Available at: http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf. Accessed February 05, 2024.

Niiranen TJ, Hänninen MR, Johansson J, et al. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension. 2010;55(6):1346-1351.

Niiranen TJ, Johansson JK, Reunanen A, et al. Optimal schedule for home blood pressure measurement based on prognostic data: the Finn-Home Study. Hypertension. 2011;57(6):1081-1086.

Niiranen TJ, Jula AM, Kantola IM, et al. Prevalence and determinants of isolated clinic hypertension in the Finnish population: the Finn-HOME study. J Hypertens. 2006;24(3):463-470.

O'Brien E, Asmar R, Beilin L, et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005;23:697.

O'Brien E, Parati G, Stergiou G. Ambulatory blood pressure measurement: What is the international consensus? Hypertension. 2013;62:988-994.

O'Brien E, Waeber B, Parati G, et al. Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ. 2001; 322(7285):531-536.

Ohkubo T, Kikuya M, Metoki H, et al. Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol. 2005;46(3):508-515.

Parati G, Pickering TG. Home blood-pressure monitoring: US and European consensus. Lancet. 2009;373(9667):876-878.

Parati G, Stergiou GS, Asmar R, et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008;26(8):1505-1526.

Parati G, Stergiou GS, Asmar R, et al. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010(12):779-785.

Pickering TG, Davidson K, Gerin W, et al. Masked hypertension. Hypertension. 2002;40(6):795-796.

Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. J Clin Hypertens (Greenwich). 2008;10(6):467-476.

Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368-2374.

Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24(1):52-58.

Piper MA, Evans CV, Burda BU, et al. Screening for high blood pressure in adults: A systematic evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 121. AHRQ Publication No. 13-05194-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.

Rickerby J. The role of home blood pressure measurement in managing hypertension: an evidence-based review. J Hum Hypertens. 2002;16(7):469-472.

Salles GF, Cardoso CR, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med. 2008;168(21):2340-6.

Satoh M, Asayama K, Kikuya M., et al. Long-term stroke risk due to partial white-coat or masked hypertension based on home and ambulatory blood pressure measurements: The Ohasama Study. Hypertension. 2016;67(1):48-55. 


Siu AL. Screening for high blood pressure in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163(10):691-700.

Stergiou GS, Skeva II, Baibas NM, et al. Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. J Hypertens. 2000;18(12):1745-1751.

Stergiou GS, Tzamouranis D, Nasothimiou EG, et al. Are there really differences between home and daytime ambulatory blood pressure? Comparison using a novel dual-mode ambulatory and home monitor. J Hum Hypertens. 2010;24(3):207-212.

Tsivgoulis G, Vemmos KN, Zakopoulos N, et al. Association of blunted nocturnal blood pressure dip with intracerebral hemorrhage. Blood Press Monit. 2005;10(4):189-195.

Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertens ion. 2020;75:1334-1357.


Urbina E, Alpert B, Flynn J, et al. Ambulatory blood pressure monitoring in children and adolescents: Recommendations for standard assessment. A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the young and the Council for High Blood Pressure Research. Hypertension. 2008;52(3):433-51.

US Preventive Services Task Force (USPSTF). Final recommendation statement hypertension in adults: screening. [USPSTF Web site]. April 27, 2021.  Available at: Recommendation: Hypertension in Adults: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org). Accessed February 05, 2024.


Valent-Morić B, Zigman T, Zaja-Franulović  O, et al. The importance of ambulatory blood pressure monitoring in children and adolescents. Acta Clin Croat. 2012;51(1):59-64.

Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287(8):1003-1010.

Verberk WJ, Kroon AA, Kessels AG, et al. Home blood pressure measurement: a systematic review. J Am Coll Cardiol. 2005;46(5):743-751.

Verdecchia P, Palatini P, Schillaci G, et al. Independent predictors of isolated clinic ('white-coat') hypertension. J Hypertens. 2001;19(6):1015-1020.

Verdecchia P, Reboldi GP, Angeli F, et al. Short- and long-term incidence of stroke in white-coat hypertension. Hypertension. 2005;45(2):203-208.

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/ PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13.

White WB. Relating cardiovascular risk to out-of-office blood pressure and the importance of controlling blood pressure 24 hours a day. Am J Med. 2008;121(8 Suppl):S2-7.​

Coding

CPT Procedure Code Number(s)
93784, 93786, 93788, 93790
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)

AMBULATORY BLOOD PRESSURE MONITORING (93784, 93786, 93788, 93790) IS MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:

G90.8Other disorders of autonomic nervous system
G90.9Disorder of the autonomic nervous system, unspecified
I10Essential (primary) hypertension
I12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I15.0Renovascular hypertension
I15.1Hypertension secondary to other renal disorders
I15.2Hypertension secondary to endocrine disorders
I15.8Other secondary hypertension
I15.9Secondary hypertension, unspecified
​I1A.0
Resistant hypertension
I95.2Hypotension due to drugs
I95.89Other hypotension
I95.9Hypotension, unspecified
R03.0Elevated blood-pressure reading, without diagnosis of hypertension
R03.1Nonspecific low blood-pressure reading


HOME BLOOD PRESSURE MONITORING DEVICES (A4660, A4663, A4670) ARE MEDICALLY NECESSARY WHEN REPORTED WITH THE FOLLOWING DIAGNOSIS CODES:
I12.0Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I13.11Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
N18.6 End stage renal disease
O10.011Pre-existing essential hypertension complicating pregnancy, first trimester
O10.012Pre-existing essential hypertension complicating pregnancy, second trimester
O10.013Pre-existing essential hypertension complicating pregnancy, third trimester
O10.019Pre-existing essential hypertension complicating pregnancy, unspecified trimester
O10.02Pre-existing essential hypertension complicating childbirth
O10.03Pre-existing essential hypertension complicating the puerperium
O10.111Pre-existing hypertensive heart disease complicating pregnancy, first trimester
O10.112Pre-existing hypertensive heart disease complicating pregnancy, second trimester
O10.113Pre-existing hypertensive heart disease complicating pregnancy, third trimester
O10.119Pre-existing hypertensive heart disease complicating pregnancy, unspecified trimester
O10.12Pre-existing hypertensive heart disease complicating childbirth
O10.13Pre-existing hypertensive heart disease complicating the puerperium
O10.211Pre-existing hypertensive chronic kidney disease complicating pregnancy, first trimester
O10.212Pre-existing hypertensive chronic kidney disease complicating pregnancy, second trimester
O10.213Pre-existing hypertensive chronic kidney disease complicating pregnancy, third trimester
O10.219Pre-existing hypertensive chronic kidney disease complicating pregnancy, unspecified trimester
O10.22Pre-existing hypertensive chronic kidney disease complicating childbirth
O10.23Pre-existing hypertensive chronic kidney disease complicating the puerperium
O10.311Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, first trimester
O10.312Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, second trimester
O10.313Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, third trimester
O10.319Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, unspecified trimester
O10.32Pre-existing hypertensive heart and chronic kidney disease complicating childbirth
O10.33Pre-existing hypertensive heart and chronic kidney disease complicating the puerperium
O10.411Pre-existing secondary hypertension complicating pregnancy, first trimester
O10.412Pre-existing secondary hypertension complicating pregnancy, second trimester
O10.413Pre-existing secondary hypertension complicating pregnancy, third trimester
O10.419Pre-existing secondary hypertension complicating pregnancy, unspecified trimester
O10.42Pre-existing secondary hypertension complicating childbirth
O10.43Pre-existing secondary hypertension complicating the puerperium
O10.911Unspecified pre-existing hypertension complicating pregnancy, first trimester
O10.912Unspecified pre-existing hypertension complicating pregnancy, second trimester
O10.913Unspecified pre-existing hypertension complicating pregnancy, third trimester
O10.919Unspecified pre-existing hypertension complicating pregnancy, unspecified trimester
O10.92Unspecified pre-existing hypertension complicating childbirth
O10.93Unspecified pre-existing hypertension complicating the puerperium
O11.1Pre-existing hypertension with pre-eclampsia, first trimester
O11.2Pre-existing hypertension with pre-eclampsia, second trimester
O11.3Pre-existing hypertension with pre-eclampsia, third trimester
O11.4Pre-existing hypertension with pre-eclampsia, complicating childbirth
O11.5Pre-existing hypertension with pre-eclampsia, complicating the puerperium
O11.9Pre-existing hypertension with pre-eclampsia, unspecified trimester
O13.1Gestational [pregnancy-induced] hypertension without significant proteinuria, first trimester
O13.2Gestational [pregnancy-induced] hypertension without significant proteinuria, second trimester
O13.3Gestational [pregnancy-induced] hypertension without significant proteinuria, third trimester
O13.4Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating childbirth
O13.5Gestational [pregnancy-induced] hypertension without significant proteinuria, complicating the puerperium
O13.9Gestational [pregnancy-induced] hypertension without significant proteinuria, unspecified trimester
O14.00  Mild to moderate pre-eclampsia, unspecified trimester
O14.02 Mild to moderate pre-eclampsia, second trimester
O14.03  Mild to moderate pre-eclampsia, third trimester
O14.04  Mild to moderate pre-eclampsia, complicating childbirth
O14.05 Mild to moderate pre-eclampsia, complicating the puerperium
O14.10 Severe pre-eclampsia, unspecified trimester
O14.12 Severe pre-eclampsia, second trimester
O14.13  Severe pre-eclampsia, third trimester
O14.14 Severe pre-eclampsia complicating childbirth
O14.15 Severe pre-eclampsia, complicating the puerperium
O14.90 Unspecified pre-eclampsia, unspecified trimester
O14.92 Unspecified pre-eclampsia, second trimester
O14.93 Unspecified pre-eclampsia, third trimester
O14.94 Unspecified pre-eclampsia, complicating childbirth
O14.95 Unspecified pre-eclampsia, complicating the puerperium
O16.1Unspecified maternal hypertension, first trimester
O16.2Unspecified maternal hypertension, second trimester
O16.3Unspecified maternal hypertension, third trimester
O16.4Unspecified maternal hypertension, complicating childbirth
O16.5Unspecified maternal hypertension, complicating the puerperium
O16.9Unspecified maternal hypertension, unspecified trimester
R03.0  Elevated blood-pressure reading, without diagnosis of hypertension
Z99.2  Dependence on renal dialysis
HCPCS Level II Code Number(s)
A4660Sphygmomanometer/blood pressure apparatus with cuff and stethoscope
A4663Blood pressure cuff only
A4670Automatic blood pressure monitor
Revenue Code Number(s)
N/A


Coding and Billing Requirements

Policy History

Revisions From 07.02.09i:
03/06/2024
​The policy has been reviewed and reissued to communicate the Company’s continuing position on Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices.

10/01/2023       

This policy has been identified for the ICD-10 code update, effective 10/01/2023.

 

The following ICD-10 code has been added to this policy:

 

  •  I1A.0  Resistant hypertension​


Revisions From 07.02.09h:

07/26/2023

​This policy has been reissued in accordance with the Company's annual review process.​​

11/2​1/2022This policy will become effective 11/21/2022.

This policy has been updated to co​mmunicate a change in the parameters for the American Heart Association Classification of Ambulatory Blood Pressure Levels in Children in accordance with the 2022 source. ​​​

Revisions From 07.02.09g:
02/​24/2021
​The policy has been reviewed and reissued to communicate the Company’s continuing position on Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices.​
04/08/2020The policy has been reviewed and reissued to communicate the Company’s continuing position on Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices.
01/01/2020This policy has been identified for the CPT code update, effective 01/01/2020.

The following narratives have been revised in this policy: 93784, 93786, 93788, 93790.

Revisions From 07.02.09f:
10/21/2019This policy will become effective 10/21/2019.

This policy has been updated to communicate a change in minimum blood pressure threshold for suspected white coat hypertension, per professional society guidelines (2017 ACC/AHA Task Force on Clinical Practice Guidelines). In addition, the following ICD-10 codes have been added to this policy: I12.9, I13.10, I95.2, I95.89, I95.9.

Revisions From 07.02.09e:
05/08/2019The policy has been reviewed and reissued to communicate the Company’s continuing position on Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices.
06/06/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices.

Effective 10/05/2017 this policy has been updated to the new policy template format.
10/1/2023
9/29/2023
3/6/2024
07.02.09
Medical Policy Bulletin
Commercial
No
Connect with Us

2024 Independence Blue Cross

Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.