CMS Proposes Expanding Coverage of Ambulatory Blood Pressure Monitoring (ABPM)
Proposal would increase access by expanding Medicare coverage to additional diagnostic applications
Today the Centers for Medicare & Medicaid Services (CMS) proposed to update its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM). ABPM is a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles. Ambulatory monitoring allows blood pressure to be measured over entire days rather than at a single moment in time. ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure (hypertension) in patients who would not otherwise have been identified as having the condition.
“With the prevalence of chronic diseases – including high blood pressure – increasing among Medicare beneficiaries, it is critical that our agency closely monitor the evidence for interventions that could improve health outcomes for patients with these conditions,” said CMS Administrator Seema Verma. “Today’s proposal to expand coverage of Ambulatory Blood Pressure Monitoring is supported by many years of evidence and would help ensure that beneficiaries have their blood pressure measured accurately, so they can receive the care that is best for them.”
The current national coverage determination for ABPM, issued in 2001, covers the diagnostic test only for those patients with suspected “white coat hypertension” who are not currently being treated for high blood pressure under specific conditions. White coat hypertension occurs when a patient’s anxiety from being in a clinical setting causes an increase in blood pressure beyond what occurs outside the clinical setting.
CMS received a request from stakeholders to reconsider this national coverage determination. Consistent with multi-society professional guidelines, CMS is proposing to update the current national coverage determination to expand access to ABPM to include coverage for cases of suspected “masked hypertension.” Masked hypertension occurs when blood pressure measurements in a doctor’s office are lower than measurements outside a doctor’s office. In addition, the decision proposes to lower the blood pressure threshold from the current policy of 140/90 to 130/80 to align with the latest society recommendations regarding the criteria for hypertension.
CMS is seeking comments on the proposed national coverage determination. All public comments may be submitted at https://www.cms.gov/medicare-coverage-database/indexes/nca-open-for-public-comment-index.aspx. A final decision will be issued no later than 60 days after the conclusion of the 30-day public comment period.
To read the proposed decision, visit the CMS website at: https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=294