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The Centers for Medicare and Medicaid Services (CMS) recently announced an expansion in coverage for Ambulatory Blood Pressure Monitoring (ABPM). This extension expands to all Medicare beneficiaries who have abnormal blood pressure rates when in a clinical setting.
Not only is this great news for patients but for manufacturers as well. With an increase in approvals for beneficiaries, manufacturers can expect to help provide many more of these medical devices to clinical facilities.
Coverage for Ambulatory Blood Pressure Monitors
Previously, CMS only covered use of the monitors for patients with blood pressure readings with “White Coat Hypertension.” White coat hypertension is anxiety with being in a medical facility setting. This condition tends to increase a patient’s blood pressure to a much higher level than what that patient’s blood pressure may be outside of a medical facility setting.
With this new decision, coverage will extend the access of this critical piece of medical equipment to also include patients with suspected masked hypertension. Masked hypertension occurs when a patient’s blood pressure measurements are lower in a physician’s office compared with those outside a clinical setting, which is the exact opposite of white coat hypertension.
Medicare covers the use of the monitor once per year for each patient. If the patient is eligible and covered, Medicare Part B coverage will help to cover the services. Medicare will cover the rental of the actual medical device.
New Blood Pressure Readings
Not only does this coverage expansion provide updated device coverage, but it has also lowered acceptable blood pressure thresholds for patients. Previously, hypertension was any reading of 140/90 or above. Now, the acceptable readings to help diagnose hypertension is 130/80 or above. The latest blood pressure readings coincide with the most recent recommendations concerning diagnostic standards.
In a statement made by CMS, an eligible patient is as follows:
“For beneficiaries with suspected white coat hypertension, which is defined as an average office blood pressure of systolic blood pressure greater than 130 mm Hg but less than 160 mm Hg or diastolic blood pressure greater than 80 mm Hg but less than 100 mm Hg on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are <130/80 mm Hg.
For beneficiaries with suspected masked hypertension, which is defined as average office blood pressure between 120 mm Hg and 129 mm Hg for systolic blood pressure or between 75 mm Hg and 79 mm Hg for diastolic blood pressure on two separate clinic/office visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥130/80 mm Hg.”
The agency also stated in its recent news release that this change "will allow more patients to use ABPM and receive appropriate treatment if needed."
According to CMS.gov, APBMs must be able to produce blood pressure measurements for 24 hours. This includes both day and night-time measurements. Also, they must be provided to patients that can provide written or oral directions. A test of the monitor must be performed in the physician's office.
How Does a Patient Qualify for an APBM?
Plenty of people suffer from high blood pressure. However, many people don’t necessarily need an ambulatory blood pressure monitor. A clinical physician may recommend the use of an ambulatory blood pressure monitor for a patient if they experience certain symptoms.
This includes any of the following:
- The patient is unable to keep their blood pressure under control.
- Patient’s blood pressure is considered “borderline.”
- A patient’s prescriptions are contributing to higher blood pressure.
- Recently updated medications.
- The patient has a history of fainting.
- A patient who is currently pregnant coupled with high blood pressure.
Beneficiaries Use APBMs
The small blood pressure cuff will connect to the monitor and automatically check the patient’s blood pressure around the clock, over 24 hours. The patient will then log a daily diary of all activities, which will help their physician have an inside look at rest times, versus active times.
After the full 24 hours of monitoring, the patient will return the machine as well as their diary to their provider’s office. From there, the physician will transfer all the blood pressure information from the monitor to a computer system.
This will better enable the provider to decipher all information received to begin a treatment plan with their patient.
With these new regulations, this critical piece of medical equipment can be used not only to help patients that are suspected to have white coat hypertension but also masked hypertension.
The change in coverage could also encourage medical device companies to develop innovative new products for monitoring blood pressure. By expanding coverage, it shows those companies that CMS is staying up to date on the latest technology, thus, keeping the door open for new technology advancements in healthcare.
This expansion is a big win for manufacturers and beneficiaries alike.