Medicare covers a device called an ambulatory blood pressure monitor for use once a year when ordered by a doctor. It does not cover regular “cuff” blood pressure monitors except for people undergoing dialysis at home.
What is an ambulatory blood pressure monitor (ABPM)?
An ambulatory blood pressure monitor (ABPM) is a device that measures and stores blood pressure readings at intervals throughout the day and night. The device includes a cuff that you wear on your arm and a recording device that you attach to your belt or clothing. You wear the device for a full 24 or 48 hours while going about your normal daily routine. You wear it while you’re awake and while you sleep. Because blood pressure levels go up and down depending on the time of day, activity levels, emotions and other factors. With an ABPM, doctors can see blood pressure levels throughout the day and night.
When Will Medicare Cover an Ambulatory Blood Pressure Monitor?
A doctor may recommend an ABPM if he or she suspects “white coat hypertension” or “masked hypertension” in a patient. A blood pressure reading that’s over 130/80 is considered high. Even if just one of the numbers is over that level – the upper number or the lower number – the reading is still high.
Usually, multiple high readings are needed for hypertension to be diagnosed. If the readings stored in the ABPM are mostly high, then the doctor may diagnose high blood pressure, also called hypertension.
“White coat hypertension”: This is when blood pressure readings are high in the doctor’s office but mostly in the healthy range at other times. This usually occurs when a patient’s anxiety from being in a clinical setting (such as a hospital or doctor’s office) causes spikes in blood pressure outside the patient’s range elsewhere.
“Masked hypertension”: This is when blood pressure readings are in the healthy range in the doctor’s office but mostly high at other times.
Medicare will cover an ABPM for “white coat hypertension” or cases of suspected “masked hypertension.”
How Much Will Medicare Pay for an Ambulatory Blood Pressure Monitor?
Medicare Part B pays 80 percent of the Medicare-approved amount to rent an ABPM. You are responsible for the remaining 20 percent. Make sure the device comes from a Medicare-certified medical equipment supplier. Other suppliers may charge more than the Medicare-approved amount, and you could end up owing the additional cost.
Medicare Advantage plans (Part C) cover ABPMs, too. Contact your plan provider to find out what your costs would be.
If you think you may need an ambulator blood pressure monitor, talk with your doctor today and with your Medicare plan provider to understand how an ABPM may be covered.
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