CMS has issued a proposal to update its national coverage policy for ambulatory blood pressure monitoring (ABPM), a noninvasive diagnostic exam designed to test for hypertension outside the clinical setting.
In a statement from the agency, CMS Administrator Seema Verma said the policy update aims to expand affordable access to ABPM, which is currently only covered for Medicare enrollees with suspected white coat hypertension. Under the proposal, ABPM would also be reimbursed for those with suspected masked hypertension.
“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,” she said. “Today’s proposal to expand coverage of ambulatory blood pressure monitoring is supported by many years of evidence and would help ensure that beneficiaries have their blood pressure measured accurately so they can receive the care that is best for them.”
White coat hypertension—when the stress and nerves associated with a doctor’s visit cause an uncharacteristic spike in a patient’s blood pressure—affects around 10% to 15% of the general population, but it’s no longer the sole focus of ABPM. CMS said it recently received a request from stakeholders to revisit the national coverage determination for ABPM to include assistance for patients with masked hypertension, a phenomenon that occurs when blood pressure measurements in a clinic are actually lower than those outside the clinic.
The agency is also proposing lowering its threshold for hypertension from the current policy of 140/90 to 130/80 to align with the latest society guidelines.
If CMS’ proposal passes, eligible patients with suspected masked or white coat hypertension will be covered for ABPM once a year, with coverage of other indications for ABPM left to the discretion of Medicare administrative contractors.
The agency opened a 30-day public comment period April 9 where it's encouraging people to voice their concerns about the new proposal. CMS said a final decision will be issued no later than 60 days after the public comment period closes.
The page has amassed 12 comments so far, around half of which are from physicians in pediatrics. While the comments were generally supportive of CMS’ move to expand the national coverage determination for ABPM, most also expressed concern that CMS didn’t include indications for children with high blood pressure.
“The lack of mentioning pediatrics and especially pediatric patients with chronic kidney disease or kidney transplant is a glaring error,” Paul Grimm, MD, medical director for the pediatric kidney transplant program at Stanford University, wrote April 12. “As a pediatric kidney transplant physician, I use ambulatory blood pressure monitoring on every patient above the age of 6 to detect masked hypertension. These patients are at high risk for masked hypertension, office blood pressure measurement is very difficult because of the anxiety and behavioral issues, the long-term complications of cardiovascular morbidity start in childhood.
“For all these reasons pediatric ambulatory blood pressure monitoring should be specifically identified as an indication, to prevent pushback from insurance companies.”
Interested parties can submit their comments here.