CMS May Expand Medicare Coverage for Blood Pressure Screening

The Centers for Medicare and Medicaid Services (CMS) is considering the expansion of Medicare coverage for ambulatory blood pressure monitoring (ABPM) devices following requests from the American Heart Association (AHA) and the American Medical Association (AMA), reports Modern Healthcare . The agency currently covers the devices in limited circumstances for individuals who experienced three high blood pressure readings during doctor visits. Researchers say these individuals have white coat hypertension and account for 15 percent to 25 percent of persons with elevated blood pressure. AHA and AMA want more people to have access to ABPM devices, even if they exhibit no symptoms of high blood pressure during an office visit. In a joint coverage request , both groups claimed that "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." According to federal data, up to 55 percent of the Medicare population has hypertension, including almost 40 percent of disabled Medicare beneficiaries. AHA estimates that individuals with high blood pressure accrue inpatient costs at 2.5 times the rate of those without high blood pressure and incur almost twice the outpatient costs, while average inpatient and outpatient costs can be as much as $5,400 annually. CMS will accept comments on the proposed expansion through Nov. 8, and it expects to release a proposed decision by next April and a final decision by July 2019.