CMS Expands Coverage of Ambulatory Blood Pressure Monitoring (ABPM)

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July 2, 2019

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CMS Expands Coverage of Ambulatory Blood Pressure Monitoring (ABPM)Decision increases access by extending Medicare coverage to additional diagnostic applications

Today the Centers for Medicare & Medicaid Services (CMS) finalized 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, allowing a doctor to assess a patient’s blood pressure during routine daily living, instead of when they are sitting nervously on an examination table.  ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure in patients who would not otherwise have been identified as having the condition.

“CMS is dedicated to improving cardiovascular health in the Medicare population,” said CMS Administrator Seema Verma.  “Today’s 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 health care. We believe stakeholders will appreciate the policy being expanded to include diagnostic uses recommended by the multi-society task force blood pressure practice guidelines.”

CMS received a request from stakeholders to reconsider this national coverage determination.  Prior to today, ABPM was covered only for those patients with suspected “white coat hypertension” 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.  Consistent with multi-society professional guidelines, today’s decision expands access to ABPM to include coverage for cases of suspected “masked hypertension,” which is essentially the opposite of white coat hypertension and occurs when blood pressure measurements in a doctor’s office are lower than measurements taken outside a doctor’s office.  

In addition, today’s decision lowers the blood pressure threshold for hypertension from the current policy of 140/90 down to 130/80 to align with the latest society recommendations regarding the diagnostic criteria.  This will allow more patients to use ABPM and receive appropriate treatment if needed.

To read the decision, visit the CMS website at: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=294