Ambulatory Blood Pressure Monitoring
Medical Policy: 01.01.02
Original Effective Date: September 2000
Reviewed: September 2011
Revised:
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Ambulatory blood pressure monitoring (ABPM) provides the physician with more detailed information on blood pressure. The greater number of readings provided by ABPM are more representative of the normal circadian rhythm of blood pressure, as compared to the limited number of readings with typical, casual office measurement. In evaluating patients who have elevated office blood pressure, ABPM could result in improved health outcomes, if it identified patients who are not at increased risk for adverse cardiovascular events and who would not benefit from treatment with antihypertensive medications. Since this group of patients would otherwise be treated based on office blood pressure readings alone, ABPM could improve outcomes by allowing these patients to avoid unnecessary treatment.
Ambulatory blood pressure monitors (i.e. 24-hour sphygmomanometers) are portable devices that record blood pressure while the patient is involved in daily activities. There are several types of monitors, including:
- Intra-arterial, which are used exclusively as research tools due to the risk of infection or arterial damage and tissue necrosis
- Fully automated, which inflate at pre-programmed intervals
- Semi-automated, which are patient activated
- Transtelephonic, which allows use of the telephone to transmit measured automatic digital readings to a computer-assisted receiver
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Prior Approval:
Not applicable
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Policy:
Ambulatory blood pressure monitoring may be considered medically necessary when at least one of the following criteria have been met:
- Unusual variability of blood pressure over the same or different visits
- Suspected white coat hypertension
- Symptoms suggesting hypotensive episodes or
- Hypertension resistant to drug treatment
Ambulatory blood pressure monitoring is considered investigational if at least one of the criteria listed above are not met, and for all other applications.
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- CPT Procedure codes ranging from 93784 thru 93790 may be used for reporting this service.
- 93784; Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
- 93786; Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only
- 93788; Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report
- 93790; Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; physician review with interpretation and report
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Selected References:
- Mancia G, Parati G. Ambulatory pressure monitoring and organ damage. Hypertension 2000; 36:894-900.
- Verdecchia P, Prognostic value of ambulatory blood pressure; Current evidence and clinical implications. Hypertension 2000; 35:844-851.
- Tremel F, Gaudemaris RD. Clinical value of ambulatory blood pressure monitoring. Journal of Hypertension 1999; 17:585-985
- Little P, Barnett J, Barnsley L, Morjoram J, Fitzgerald-Barron A, Mant D. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ 2002; 325:258-259.
- O’Brien E, Coats A, Owens P, Petrie J, Padfield PL, Littler WA, Swiet MC, Mee F. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 2000; 320:1128-1134.
- American College of Cardiology Position Statement. Journal of the American College of Cardiology 1994;23:1511-3.
- Staessen JA, Thijs L, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA. 1999 Aug 11;282(6):539-46.
- White WB. Ambulatory Blood Pressure Monitoring in Clinical Practice. N Eng J Med 348;24 June 2003.
- Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008 Jul;52(1):1-9. Epub 2008 May
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. NIH Publication No. 04-5230. August 2004
- ECRI. Continuous Ambulatory Blood Pressure Monitoring. Plymouth Meeting (PA): ECRI Health Technology Information Service; 2007 June 21. 5p. (ECRI Hotline Response). Also available: http://www.ecri.org.
- Hodgkinson J, Martin U, Guo B et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342:d3621 doi: 10.1136/bmj.d3621
- Eguchi K. Ambulatory blood pressure monitoring in diabetes and obesity-a review. Int J Hypertens. 2011;2011:254757. Epub 2011 Mar 28.
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Policy History:
Date Reason Action
September 2011 Annual review Policy renewed
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*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.
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