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Medical Policy: 01.01.02
Original Effective Date: September 2000
Reviewed: June 2008
Revised:
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
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
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, 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
- HCPCS A4670; Automatic blood pressure monitor
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Selected References:
- The Medical Policy Reference Manual (MPRM) developed by the Blue Cross Blue Shield Association Health management Systems, based on Technology Evaluation Center (TEC) criteria.
- A review of the medical literature and recommendations from Wellmark's Medical Policy Advisory Council (MPAC), a council of practicing physicians who advise and assist Wellmark in the development and implementation of medical policies. The council is comprised of primary care and specialty physicians from Iowa and South Dakota.
- 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.
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
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