The Centers for Medicare & Medicaid Services (CMS) has proposed an update to its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles.
Because this method measures blood pressure during an entire day(s) and not during a single visit, it is believed to capture a truer measure of a patient’s blood pressure which could lead to more hypertension diagnoses among patients who might not have been identified.
“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 in a press release. She added that years of medical research supports the use of ABPM and adopting the practice would increase quality in care delivery.
The current national coverage determination for ABPM, issued in 2001, covers the diagnostic test only for those patients with suspected white coat hypertension – when a patient’s blood pressure becomes elevated due to the stress of being in a clinical setting – and is not receiving treatment for high blood pressure under specific conditions.
CMS said after receiving stakeholder requests to provide the coverage, consistent with multi-society professional guidelines, the agency is proposing to update the current national coverage determination and give access to ABPM for cases of suspected masked hypertension – when a patient’s blood pressure measured during an office visit is actually lower when not in a clinical setting.
CMS also 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. Public comments are being collected over a thirty-day period with a final decision to come no later than 60 days after the comment period closes.
