The CMS is considering expanding Medicare coverage for ambulatory blood pressure monitoring (ABPM) devices after requests from the American Heart Association and the American Medical Association.
The devices are used to determine blood pressure over 24-hour cycles, which allows patients and providers to see trends over time rather than moments in a doctor's office. The measurements are stored in the device and later interpreted by a physician.
The CMS currently covers the devices in limited circumstances for individuals who experienced three high blood pressure readings during doctor visits. These individuals have so-called white coat hypertension and represent 15% to 25% of patients with elevated blood pressure, according to researchers.
AMA and AHA want more patients to have access to the devices, even if they may not show signs of high blood pressure during an office visit.
"ABPM has been shown to be effective at diagnosing a number of blood pressure patterns and comorbid conditions prevalent in the Medicare population which can help ensure Medicare beneficiaries receive appropriate treatment tailored to their individual health needs," the associations say in a joint coverage request posted Tuesday.
The AMA increasingly has focused on seeking reimbursement for virtual care. Last year, it published new billing codes for web-based consultations and remote monitoring to allow providers to bill for keeping an eye on certain patient metrics remotely, like blood pressure and weight.
Federal data indicate that up to 55% of the Medicare population has hypertension, including nearly 40% of disabled Medicare beneficiaries.
Patients with high blood pressure rack up inpatient costs at 2.5 times the rate of patients without high blood pressure and incur almost double the outpatient costs, according to the American Heart Association.
Average inpatient and outpatient costs can be as much as $5,400 annually, according to AHA.
The CMS will accept comments on the proposed coverage expansion through Nov. 8. It expects to issue a proposed decision by next April and a final decision by July 2019.
