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Does Medicaid Cover Blood Pressure Monitors

Does Medicare Or Medicaid Cover Blood Pressure Monitors

Medicare & You: Diabetes

The American Heart Association estimates that nearly half of adults in the United States have high blood pressure, often referred to as the silent killer because it increases the risk of heart attacks and strokes.

High blood pressure is treatable but cant be treated unless it is diagnosed. Thats where blood pressure monitors come in.

While Original Medicare doesnt typically cover blood pressure monitors, some states Medicaid programs may provide coverage. Each state has its plan for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need and/or disability regardless of age.

Need More Information About Home Blood Pressure Monitors

If you have questions about Medicare coverage of blood pressure monitors or other types of equipment, I am happy to help. If youd like a phone call or email with personalized information, click the corresponding link below. The Compare Plans button will show you information about plan options you may be eligible for.

How Much Does A Blood Pressure Monitor Cost With And Without Supplemental Insurance

Part B covers ambulatory blood pressure monitors. If you have a Medicare Supplement plan, your costs will be lower. Other types of home blood pressure monitors arent covered by Medicare or by Medicare Supplement policies.

If you have high blood pressure, the American Heart Association recommends an automatic monitor that uses a cuff around your bicepsimilar to the device in a doctors office.

Wrist and finger monitors are also available, but they arent as reliable. You can expect to pay around $25-35 for a monitor that features an arm cuff and a digital reading. Smart monitors that can store data or synch with phones and smartwatches are likely to cost around $80-$100.

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New York State Regional Extension Centers

NYS RECs offer free support to help providers achieve Meaningful Use of CEHRT. Support provided by NYS RECs includes, but is not limited to, the following:

  • Answers to questions regarding the program and requirements
  • Assistance on selecting and using CEHRT
  • Help meeting program objectives

NYS RECs offer free assistance for all practices and providers located within New York.

For Providers Located:

How Can You Manage Hypertension

Self Measured Blood Pressure Monitoring

High blood pressure or hypertension can potentially lead to complications such as heart disease, risk of stroke and kidney damage if not controlled and/or treated with medication. Here are some healthy tips for individuals diagnosed with hypertension to consider implementing into their routines.

  • Take blood pressure medication as prescribed
  • Overweight individuals should do their best to lose weight and follow heart-healthy diets
  • Reduce alcohol intake
  • Participate in activities that help lower stress levels such as yoga, meditation or simply relaxing when necessary
  • Monitor blood pressure at home on a regular basis

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Invasive Congestive Heart Failure Monitoring

Aetna considers implantable congestive heart failure monitors experimental and investigational because such devices have not been shown to improve clinical outcomes compared to standard methods of heart failure monitoring.

Aetna considers an implantable wireless pulmonary artery pressure monitor experimental and investigational for heart failure and all other indications. CardioMems pillow and other components associated with CardioMems are also considered experimental and investigational.

Pharmacy Update On Dose Optimization Program

Effective February 27, 2020, the New York State Medicaid fee-for-service program will update the Dose Optimization initiative with the drugs listed below. Dose optimization can reduce prescription costs by reducing the number of pills a patient needs to take each day. The NYS Department of Health has identified drugs to be included in this program, the majority of which have Food and Drug Administration approval for once-a-day dosing, have multiple strengths available in correlating increments at similar costs, and are currently being utilized above the recommended dosing frequency. Prior authorization will be required to obtain the following medication beyond the following limits:


Tablet None

PA requirements are not dependent on the date a prescription is written. New prescriptions and refills on existing prescriptions require PA even if the prescription was written before the date the drug was determined to require a PA. To obtain a PA, providers may contact the Clinical Call Center at 3099493. The Clinical Call Center is available 24 hours per day, seven days per week and staffed with pharmacy technicians and pharmacists available to assist providers in quickly obtaining a PA.

Current information on the Medicaid FFS Pharmacy PA Programs, including the Dose Optimization initiative, can be found at: . This document contains a full list of drugs subject to the NYS Medicaid FFS Pharmacy Programs.

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Cpt Codes Not Covered For Indications Listed In The Cpb:

93050 Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform, digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive

What Blood Pressure Monitoring Equipment Does Medicare Pay For

Self-Measurement: How patients and care teams are bringing blood pressure to control

Medicare Part B medical insurance may sometimes cover blood pressure monitors if:

  • You are undergoing renal dialysis at home
  • Your doctor recommends an ambulatory blood monitoring device .An ABPM is a non-invasive monitor that measures your blood pressure in 24-hour cycles and stores the measurements in the device. An ABPM is only covered by Medicare if your doctor determines that you have suspected white coat hypertension .

We recommend that you speak with your doctor directly to learn more about blood pressure monitors and whether or not they are recommended for your use.

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Medicaid Taxi/livery Reimbursement Fee Reduction

The Enacted 2020-2021 State Budget and Medicaid Redesign Team II initiative will decrease Medicaid Taxi/Livery base and mileage fees by 7.5 percent effective June 1, 2020. The updated fees effective for dates of service on or after June 1, 2020 are posted at: .

Are Blood Pressure Monitors Covered By Medicare

Blood pressure monitors for use at home arent covered by Medicare, with two exceptions:

  • A blood pressure monitor and stethoscope for a patient receiving blood dialysis in the home
  • An ambulatory blood pressure monitoring device, which takes and stores blood pressure readings in 24-hour cycles, for a patient who, a physician believes, has white coat hypertension based on repeated in-office and out-of-office testing

If covered, Medicare Part B pays for the rental of the blood pressure monitoring device. The monitor must be rented from a Medicare-certified medical equipment supplier.

Medicare Part C plans, also called Medicare Advantage plans, must cover everything thats included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. Co-payments for Part C plans may also be different than those for Part A or Part B. To find out whether your plan provides extra coverage or requires different co-payments for a blood pressure monitor, contact the plan directly.

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How Does A Blood Pressure Monitor Help Me Manage My Hypertension

According to the American Heart Association, all people being treated for high blood pressure should monitor their blood pressure at home to help their doctors ensure their treatment is effective.

While using an at-home blood pressure monitor shouldnt be a substitute for seeing a doctor regularly and having your hypertension monitored by a health-care provider, it can help your health-care team have a more accurate idea of your condition over time. When your blood pressure is taken at the doctors office, it is just a snapshot of your condition at that particular moment. By measuring your blood pressure regularly at home, your doctor has more data to work with. Having multiple blood pressure measurements taken over a range of time gives your physician a more complete picture of how your blood pressure is responding to treatment and whether your medications are properly managing your hypertension.

Again, using a blood pressure monitor at home should not be a substitute for consulting your doctor. Its important to continue to take your hypertension medications unless your doctor advises otherwise, even if you get several measurements in the normal blood pressure range.

Ambulatory Blood Pressure Monitoring


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

A. General

Ambulatory Blood Pressure Monitoring is a diagnostic test that allows for the identification of various types of high blood pressure . ABPM devices are small portable machines that are connected to a blood pressure cuff worn by patients that record blood pressure at regular periods over 24 to 48 hours while the patient goes about their normal activities, including sleep. The recording is interpreted by a physician or non-physician practitioner, and appropriate action is taken based on the findings. Diagnosis and treatment of high BP is important for the management of various conditions including cardiovascular disease and kidney disease.

B. Nationally Covered Indications

For dates of service on and after July 2, 2019, the Centers for Medicare & Medicaid Services believes that the evidence is sufficient to determine that ABPM is reasonable and necessary for the diagnosis of hypertension in Medicare beneficiaries under the following circumstances:

  • For beneficiaries with suspected white coat hypertension, which is defined as average office BP of systolic BP > 130 mm Hg but < 160 mm Hg, or diastolic BP > 80 mm Hg but < 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit, and with at least two BP measurements taken outside the office which are < 130/80 mm Hg.
  • ABPM devices must be:

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    Follow These Guidelines When Placing Orders

    Digital blood pressure cuffs for home use are a covered benefit for California Health & Wellness Plan members. CHWP has made special arrangements with Western Drug Medical Supply, a durable medical equipment supplier, to stock and provide these items, which are not easily available from other DME suppliers.

    What you need to know before placing an order.

    • Blood pressure cuffs are a Medi-Cal covered benefit for any ICD-10-CM diagnosis code that justifies medical necessity.
    • Members are limited to one digital blood pressure cuff per member every five years. Units are provided with instructions and batteries.
    • Members must select an automated digital device to support quality improvement reporting.
    • A prescription is not required but would be helpful to ensure the correct item is selected.
    • Prior authorization is not required. However, providers are required to submit a written DME order.
    • The order should include the following:
    • Patients name
    • The providers full name and signature
    • HCPCS code: A4670-NU Automatic Blood Pressure Monitor
    • Date of service

    A fax cover sheet must accompany all fax transmissions of Protected Health Information. The cover sheet must be labeled PROTECTED HEALTH INFORMATION.

    Members will receive their equipment 24-48 hours after the DME supplier verifies the members eligibility and confirms the mailing address. Members who have questions or who have defective equipment can call Western Drug Medical Supply directly at 1-800-891-3661.

    Additional Information

    Cms Expands Medicare Coverage Of Blood Pressure Monitoring Device

    The CMS announced Tuesday it has extended coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.

    The agency previously only covered the use of the device, which monitors blood pressure periodically over a 24-hour period, for patients with suspected elevated blood pressure levels due to anxiety from being in a clinical setting. The device can now also be used for patients suspected of having lower than usual blood pressure measurements when inside a doctor’s office. Medicare will cover the use of the device once a year per patient.

    The devices, called ambulatory blood pressure monitoring, is helpful for clinicians with patients who are nervous in clinical settings, affecting the accuracy of their blood pressure results. The devices track patient’s blood pressure throughout the day and the accrued data allows doctors to understand patient’s blood pressure during normal activity.

    CMS Administrator Seema Verma said in a statement that the agency “is dedicated to improving cardiovascular health in the Medicare population. 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 healthcare.”

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    Medicare Coverage For Blood Pressure Monitors

    Home / FAQs / Medicare Coverage / Medicare Coverage for Blood Pressure Monitors

    Medicare coverage for home blood pressure monitors is available under certain conditions. For example, if youre undergoing home kidney dialysis. In some scenarios, Medicare will pay for the temporary use of a different kind of blood pressure device called an ambulatory blood pressure monitor. Below well go over the details of coverage, cost, and guidelines for Medicare coverage on blood pressure monitors.

    New York Medicaid Ehr Incentive Program

    How To: Root with Noninvasive Blood Pressure and Temperature Product Training
    Distribution to Eligible Professionals & Eligible Hospitals Since the Start of the Program in 2011*

    Number of Payments:

    *As of 5/22/2020

    Through the New York Medicaid Electronic Health Record Incentive Program, eligible professionals and eligible hospitals in New York who adopt, implement, or upgrade certified EHR technology and subsequently become meaningful users of CEHRT, can qualify for financial incentives. The Centers for Medicare and Medicaid Services is dedicated to improving interoperability and patient access to health information. The NY Medicaid EHR Incentive Program is a part of the CMS Promoting Interoperability Program, but will continue to operate under the current name, NY Medicaid EHR Incentive Program.

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    New System Edit On Ffs Pcmh And Apc Claims

    A new system edit was implemented into the eMedNY claiming system as of January 23, 2020 for all Medicaid FFS institutional claims. This edit withholds the PCMH or APC incentive payment in situations where the ZIP+4 code submitted on the claim was not located on the provider’s rate file for the submitted rate code. The inability for the eMedNY system to locate the submitted ZIP+4 code on the provider’s rate file causes the claim to trigger edit “02068” . The PCMH or APC incentive payment will be withheld from any FFS institutional claim that triggers edit “02068”. The FFS institutional claim will still adjudicate as normal however, the PCMH or APC incentive payment will be withheld. Providers are responsible for reviewing their remit statements to ensure payment of the PCMH or APC incentive. Providers must resubmit a claim adjustment to Medicaid with the correct ZIP+4 code that reflects the actual service location to be eligible to receive the incentive payment.

    Mobile Health Tracking Devices

    Mena and associates stated that mobile ECG monitoring is an emerging area that has received increasing attention in recent years, but still real-life validation for elderly residing in low and middle-income countries is scarce. These researchers developed a wearable ECG monitor that is integrated with a self-designed wireless sensor for ECG signal acquisition. It is used with a native purposely designed smartphone application, based on machine learning techniques, for automated classification of captured ECG beats from aged people. When tested on 100 older adults, the monitoring system discriminated normal and abnormal ECG signals with a high degree of accuracy , sensitivity , and specificity . The authors concluded that with further verification, the system could be useful for detecting cardiac abnormalities in the home environment and contribute to prevention, early diagnosis, and effective treatment of cardiovascular diseases, while keeping costs down and increasing access to healthcare services for older persons.

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    Zoll Heart Failure And Arrhythmia Management System

    ZOLL Heart Failure and Arrhythmia Management System , a patch-based, wireless system that employs radiofrequency technology, is designed to aid physicians improve outcomes and reduce hospitalizations for patients with acute heart failure who have fluid management problems. It is a non-invasive and water-resistant sensor that can be worn by patients 24 hours a day for monitoring of pulmonary fluid levels as an early indicator for heart failure decompensation. Once placed on a patients body, it continuously records patient data including heart rate , heart rhythm , respiration rate, and thoracic fluid index. Physicians are notified according to pre-defined criteria to aid in the diagnosis and identification of various clinical events and/or trends thus, allowing physicians to provide timely intervention if needed. Physicians can login to a unified portal to review the monitoring results.

    There is a lack of evidence on the effectiveness of the ZOLL Heart Failure and Arrhythmia Management System in improving the health outcomes of patients with HF.

    Code Code Description

    Important Legislation Regarding Drugs To Treat Substance Use Disorders:

    Self Measured Blood Pressure Monitoring
    • Medicaid policy requires Medicaid fee-for-service and Medicaid Managed Care to provide at least five days’ coverage for emergencies, without prior authorization, for medications used to treat substance use disorders. This includes medication associated with the management of opioid withdrawal and/or stabilization as well as medication used for opioid overdose reversal.
    • As published in the issue of the Medicaid Update, New York State Social Services Law §364-j and Public Health Law §273, prohibit prior authorization under Medicaid FFS and MMC for initial or renewal prescriptions for preferred or formulary forms of buprenorphine or injectable naltrexone when used for detoxification or maintenance treatment of opioid addiction. The frequency, quantity, and/or duration limits supported by the Food and Drug Administration and Compendia may continue to be applied.

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    New York State Medicaid Fee

    Effective July 1, 2020, New York State Medicaid fee-for-service will begin utilizing criteria to determine the approval of crizanlizumab-tmca for members with sickle cell disease to reduce the frequency of vasoocclusive crises when the member meets the criteria outlined in this policy. ADAKVEO® was approved by the U.S. Food and Drug Administration for use on November 15, 2019.


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