Medicare has coverage of Ambulatory Blood Pressure Monitoring. ABPM is a newer method that assesses a patient’s blood pressure. This monitoring allows your provider to review your blood pressure while you go through your everyday, real-life routine.
This can be beneficial as nerves tend to increase your blood pressure at doctor’s appointments. Ambulatory Blood Pressure Monitoring helps to determine whether a patient does, in fact, have hypertension. Medicare knows it’s been extremely beneficial in assessing individuals with “white-coat hypertension.”
Ambulatory Blood Pressure Monitoring (ABPM)
Just because you may have high blood pressure, does not necessarily mean that you’ll need an APBM.
The physician may recommend the use of an ambulatory blood pressure monitor if you experience:
- Unable to keep your blood pressure under control.
- Blood pressure is “borderline”
- Prescriptions are contributing to higher blood pressure
- Recently changed medications
- Have a history of fainting
- Currently pregnant and are having high blood pressure
How ABPM Works
A small blood pressure cuff connects to a monitor and automatically checks a patient’s blood pressure right around every thirty minutes. It will monitor your daily routine and will even continue monitoring while you’re sleeping at night.
A daily journal will be kept of your daily activities, which helps give your physician an inside look at when you were resting, versus when you were active.
After a full 24 hours of monitoring, you’ll return the machine and your journal to your provider’s office. From there, your doctor will transfer all the blood pressure information from the monitor to a computer system.
At this point, your doctor will better be able to decipher the information gathered. Then, your doctor will determine a treatment for you.
Medicare Coverage for Ambulatory Blood Pressure Monitoring
Medicare will cover the rental of a blood pressure monitor. The monitor must be rented from a Medicare-certified equipment supply store.
As stated by CMS, an eligible patient is as follows:
“For beneficiaries with white coat hypertension, 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 and at least two blood pressure measurements outside the office <130/80 mm Hg.
For beneficiaries with hypertension, an 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 at each visit and with at least two blood pressure measurements outside the office ≥130/80 mm Hg.”
According to CMS APBMs must:
- Be able to produce blood pressure measurements for 24 hours. This includes both day and night-time measurements.
- Be clear, patients can provide written or oral directions. A test of the monitor must be in the physician’s office.
- Understood by the treating physician.
- Expansion of Coverage for APBM Patients
Medicare Covers ABPM
Recently, the Centers for Medicare and Medicaid Services (CMS) came to the end of the finalization of its coverage policy for ABPM. In the past, this health care service was only covered for patients who were suspected to have “white coat hypertension” and fell under explicit conditions.
Whitecoat hypertension is caused by a patient’s anxiety from being in a medical facility setting. This anxiety increases a patient’s blood pressure to a much higher level than what that patient’s blood pressure may be outside of a clinical setting.
The new decision made by CMS will extend access to APBM services 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 to outside a clinical setting. Essentially the opposite of white coat hypertension.
Not only did the recent decision help expand coverage for patients, but it also helped to lower the blood pressure threshold for patients. The prior policy constituted that a patient’s blood pressure constituted hypertension at a pressure reading of 140/90.
The new decision has lowered the blood pressure reading to 130/80, which coincides with the latest recommendations concerning diagnostic standards. This decision means that more patients will be able to use Ambulatory Blood Pressure monitors and will be able to receive appropriately tailored care.
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