CMS to cover ambulatory BP monitoring for patients with suspected hypertension
CMS has issued a decision memo stating that the evidence is sufficient for the coverage of ambulatory BP monitoring in Medicare beneficiaries with suspected white coat hypertension or masked hypertension.
The decision, written by Tamara Syrek Jensen, JD, director of the coverage and analysis group for CMS, and colleagues, is a modification of the 2001 National Coverage Determination, which only suggested ambulatory BP monitoring for patients with documented suspected white coat hypertension. A formal request for reconsideration by CMS was submitted by the American Heart Association and the AMA in October.
Compared with office BP monitoring, ambulatory BP monitoring devices produce a large number of readings in the patient’s regular environment.
The use of ambulatory BP monitoring was referenced in several guidelines and recommendation statements. The annual use of these devices and home BP monitoring were recommended by the United States Preventive Services Task Force in 2015. The use of ambulatory BP monitoring was also referenced in the Guideline for Prevention, Detection, Evaluation and Management of High BP in Adults published in 2017, which redefined high BP at 130/80 mm Hg.
According to the 2013-2016 National Health and Nutrition Examination Survey, 67.4% of women and 61.1% of men aged 65 to 75 years had hypertension. This increased to 78.7% of women and 67.4% of men when assessing prevalence in those older than 75 years.
The prevalence of white coat hypertension and masked hypertension increases with age and are both more likely in men. Both conditions are linked to long-term mortality, metabolic syndrome and CV endpoints.
The decision also focuses on the ambulatory BP monitoring devices themselves, stating that they should be able to produce standardized BP measurement plots for 24 hours that indicate normal BP and daytime and nighttime windows. The devices should be given to patients with written and oral instructions and should undergo a test run in the office. Results from the ambulatory BP monitoring devices should be interpreted by a treating physician or nonphysician practitioner, according to the decision memo.
The Medicare Administrative Contractors will decide if coverage for other indications for ambulatory BP monitoring is appropriate.
“First, we have removed the 2001 requirement that [office BP monitoring] be measured at > 140/90 on two separate occasions,” Syrek Jensen and colleagues wrote. “Second, we have removed the 2001 requirement that there be no evidence of end-organ damage. We believe that the published evidence does not support this this criterion. Third, there is a substantial proportion of patients who may appear to be in control or be normotensive, but have masked hypertension. The published evidence supports the use of [ambulatory BP monitoring] to improve outcomes.” – by Darlene Dobkowski