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Ambulatory Blood Pressure Monitoring (ABPM)

Section: Diagnostic Medical
Effective Date: November 01, 2019
Revised Date: October 09, 2019
Last Reviewed: September 26, 2019

Description

Ambulatory blood pressure monitoring is typically done over a 24-hour period with a fully automated monitor. This provides more detailed blood pressure information than a traditional reading obtained during office visits. The greater number of readings with ABPM ameliorates the variability of single blood pressure measurements and is more representative of the circadian rhythm of blood pressure compared to the limited number obtained during an office measurement.

Criteria

Ambulatory Blood Pressure Monitoring (ABPM) maybe be considered medically necessary for ANY of the following indications:

Adults

  • Suspected white coat hypertension (WCH) with no evidence of end-organ damage;
    • The physician has performed at least three blood pressure measurements at least one (1) week apart in the office; and
    • Blood pressure measurements by non-physicians (e.g., nurse, technician) in the office have been done and stage one hypertension readings have been obtained but <180/110, not requiring immediate treatment with medications; and
    • Member has repeated blood pressure measurements at home over at least one (1) month, and the diagnosis of hypertension remains in question; or
  • Resistant hypertension in individuals who are being treated with three (3) or more medications; or Hypertensive individuals with hypotensive symptoms thought to be related to antihypertensive medications or neurological symptoms; or
  • For individuals whose symptomatology (paroxysms of excessive sweating, palpitations, apprehension) suggest episodic hypertension secondary to an adrenal tumor and office blood pressure measurements are repeated normal; or
  • For evaluation of syncope or near syncope when used in conjunction with a 24 hour Holter monitor to determine whether symptoms are the direct result of an arrhythmia; or
  • To investigate blood pressure changes in individuals nocturnal angina.

Procedure Codes

93784  93786  93788 93790

Children/Adolescents

ABPM may be considered medically necessary in children/adolescents greater than or equal to age five (5) in ANY of the following settings:

  • Confirming the diagnosis of hypertension including differentiating true hypertension from “white coat” hypertension:
    • When office blood pressure measurements are in the elevated blood pressure category for one (1) year or more; or
    • When blood pressure measurements fall within the Stage 1 HTN category over three (3) clinic visits at least one (1) to two (2) weeks apart; or
    • When blood pressure measurements fall within the Stage 2 HTN category twice within one (1) week; or
  • Assessing symptoms related to suspected drug-related hypotension; or
  • Drug resistant hypertension; or
  • To assess effectiveness of hypertensive treatment; or
  • Children and adolescents with ANY of the following:
    • A history of aortic coarctation; or
    • A history of low birth weight; or
    • Chronic Kidney Disease (CKD) and structural renal abnormalities; or
    • Endocrine disorders associated with hypertension (e.g. Congenital adrenal hyperplasia, familial hyperaldosteronism, etc.); or
    • Genetic syndromes associated with hypertension (e.g. neurofibromatosis, Turner syndrome, Williams syndrome, sickle cell disease, etc.); or
    • Obesity; or
    • Sleep-Disordered Breathing (SDP); or
    • Type 1 Diabetes Mellitus (T1DM); or
    • Type 2 Diabetes Mellitus (T2DM).

ABPM in children and adolescents should be used by experts in the field of pediatric nephrology and pediatric cardiology who are experienced in its use and interpretation.

ABPM for any other indication is considered experimental/investigational and therefore, non-covered, due to lack of supporting published peer reviewed literature.

Procedure Codes

93784  93786  93788 93790

ABPM is considered experimental/investigational and therefore non-covered in ANY of the following situations because the medical literature does not support its use in these conditions:

  • For blood pressure monitoring of individuals with heart failure; or
  • For blood pressure monitoring of pregnant women who do not meet any of the criteria listed above; or
  • For diagnosing malignant hypertension. Under accepted guidelines, malignant hypertension requires urgent hospital admission for appropriate investigation and treatment; or
  • For individuals with an irregular cardiac rhythm (e.g., atrial fibrillation); or
  • For monitoring normal blood pressure readings in the medical setting of individuals with documented evidence of end-organ damage (e.g., nephropathy, electrocardiographical changes, left ventricular hypertrophy, angina, myocardial infarction, cerebrovascular accident, transient ischemic attack) or cardiovascular risk factors (e.g., diabetes mellitus, smoking, hypercholesterolemia); or

ABPM for more than 24 hours is considered not medically necessary.

Procedure Codes

93784  93786  93788 93790

Non-invasive assessment of central blood pressure (e.g., SphygmoCor System) is considered experimental/investigational and therefore non-covered.  The long-term efficacy has not yet been established.

Procedure Codes

93050

Adults

BP Classification Systolic BP, mm Hg*   Diastolic BP, mm Hg*
Normal <120 and <80
Prehypertension 120-129 and <80
Stage 1 Hypertension 130-139 or 80-89
Stage 2 Hypertension > 140 or > 90

Children

For Children aged one (1)- < 13 Years of Age For Children Aged ≥13 Years of Age
Normal BP: <90th percentile Normal BP: <120/<80 mm Hg
Elevated BP: ≥90th percentile to <95th percentile or 120/80mm Hg to <95th percentile (whichever is lower) Elevated BP: 120/<80 to 129/<80 mm Hg
Stage 1 HTN: ≥95th percentile to <95th percentile + 12 mmHg, or 130/80 to 139/89 mm Hg (whichever is lower) Stage 1 HTN: 130/80 to 139/89 mm Hg
Stage 2 HTN: ≥95th percentile + 12 mm Hg, or ≥140/90 mm Hg (whichever is lower) Stage 2 HTN: ≥140/90 mm Hg

Professional Statements and Societal Positions

Screening for high blood pressure in adults: U.S. Preventive Services Task Force (USPSTF) recommendation statement. 2015.

The USPSTF found convincing evidence that ABPM is the best method for diagnosing hypertension. Elevated ambulatory systolic blood pressure was consistently and significantly associated with increased risk for fatal and nonfatal stroke and cardiovascular events, independent of office blood pressure. For these reasons, the USPSTF recommends ABPM as the reference standard for confirming the diagnosis of hypertension.

Diagnosis Codes  

Covered Diagnosis Codes

C74.00 C74.01 C74.02 D44.7 D57.00 D57.01 D57.02
D57.1 D57.20 D57.211 D57.212 D57.219 D57.3 D57.40
D57.411 D57.412 D57.419 D57.80 D57.811 D57.812 D57.819
E05.00 E05.01 E05.10 E05.11 E05.20 E05.21 E05.30
E05.31 E05.40 E05.41 E05.80 E05.81 E05.90 E05.91
E10.9 E11.9 E21.0 E21.1 E21.2 E21.3 E21.4
E21.5 E24.0 E24.8 E24.9 E26.01 E26.02 E26.09
E66.8 E66.9 F84.3 G47.30 G47.31 G47.32 G47.33
G47.34 G47.35 G47.36 G47.37 G47.39 I10 I11.9
I15.0 I15.1 I15.2 I15.8 I15.9 I20.8 I95.0
I95.1 I95.2 I95.3 I95.81 I95.89 I95.9 N18.1
N18.2 N18.3 N18.4 N18.5 N18.6 N18.9 N26.2
Q78.1 Q85.00 Q85.01 Q85.02 Q85.03 Q85.09 Q93.82
Q96.0 Q96.1 Q96.2 Q96.3 Q96.4 Q96.8 Q96.9
R03.0 R55 Z00.00 Z00.01 Z00.110 Z00.111 Z00.121
Z00.129 Z01.31 Z01.411 Z01.419 Z01.83 Z11.2 Z11.3
Z11.4 Z11.51 Z11.59 Z12.10 Z12.11 Z12.12 Z12.31
Z12.39 Z12.4 Z12.5 Z12.73 Z13.1 Z13.21 Z13.220
Z13.228 Z13.30 Z13.31 Z13.32 Z13.39 Z13.40 Z13.41
Z13.42 Z13.49 Z13.5 Z13.6 Z13.79 Z13.811 Z13.820
Z13.83 Z29.3 Z30.011 Z30.012 Z30.013 Z30.014 Z30.015
Z30.016 Z30.017 Z30.018 Z30.02 Z30.09 Z30.40 Z30.41
Z30.42 Z30.430 Z30.431 Z30.432 Z30.433 Z30.44 Z30.45
Z30.46 Z30.49 Z30.9 Z31.7 Z33.3 Z70.0 Z70.1
Z70.3 Z70.8 Z70.9 Z71.83 Z87.74

Non-covered diagnosis codes

E09.21 E09.22 E09.29 E10.10 E10.11 E10.21 E10.22
E10.29 E10.311 E10.319 E10.321 E10.329 E10.331 E10.339
E10.341 E10.349 E10.351 E10.359 E10.36 E10.39 E10.40
E10.41 E10.42 E10.43 E10.44 E10.49 E10.51 E10.52
E10.59 E10.610 E10.618 E10.620 E10.621 E10.622 E10.628
E10.630 E10.638 E10.641 E10.649 E10.65 E10.69 E10.8
E11.00 E11.01 E11.10 E11.11 E11.21 E11.22 E11.29
E11.311 E11.319 E11.321 E11.329 E11.331 E11.339 E11.341
E11.349 E11.351 E11.359 E11.36 E11.39 E11.40 E11.41
E11.42 E11.43 E11.44 E11.49 E11.51 E11.52 E11.59
E11.610 E11.618 E11.620 E11.621 E11.622 E11.628 E11.630
E11.638 E11.641 E11.649 E11.65 E11.69 E11.8 E13.00
E13.01 E13.10 E13.11 E13.21 E13.22 E13.29 E13.311
E13.319 E13.321 E13.329 E13.331 E13.339 E13.341 E13.349
E13.351 E13.359 E13.36 E13.39 E13.40 E13.41 E13.42
E13.43 E13.44 E13.49 E13.51 E13.52 E13.59 E13.610
E13.618 E13.620 E13.621 E13.622 E13.628 E13.630 E13.638
E13.641 E13.649 E13.65 E13.69 E13.8 E13.9 E78.0
E78.2 G45.0 G45.1 G45.2 G45.8 G45.9 G46.0
G46.1 G46.2 I09.81 I11.0 I12.0 I12.9 I13.0
I13.10 I13.11 I13.2 I20.0 I21.01 I21.02 I21.09
I21.11 I21.19 I21.21 I21.29 I21.3 I21.4 I21.A1
I21.A9 I22.0 I22.1 I22.2 I22.8 I22.9 I24.0
I24.1 I24.8 I24.9 I25.110 I25.2 I25.700 I25.710
I25.720 I25.730 I25.750 I25.760 I25.790 I50.1 I50.20
I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33
I50.40 I50.41 I50.42 I50.43 I50.9 I51.7 I63.00
I63.011 I63.012 I63.019 I63.02 I63.031 I63.032 I63.039
I63.09 I63.10 I63.111 I63.112 I63.119 I63.12 I63.131
I63.132 I63.139 I63.19 I63.20 I63.211 I63.212 I63.219
I63.22 I63.231 I63.232 I63.239 I63.29 I63.30 I63.311
I63.312 I63.319 I63.321 I63.322 I63.329 I63.331 I63.332
I63.339 I63.341 I63.342 I63.349 I63.39 I63.40 I63.411
I63.412 I63.419 I63.421 I63.422 I63.429 I63.431 I63.432
I63.439 I63.441 I63.442 I63.449 I63.49 I63.50 I63.511
I63.512 I63.519 I63.521 I63.522 I63.529 I63.531 I63.532
I63.539 I63.541 I63.542 I63.549 I63.59 I63.6 I63.81
I63.89 I63.9 I65.01 I65.02 I65.03 I65.09 I65.1
I65.21 I65.22 I65.23 I65.29 I65.8 I65.9 I66.01
I66.02 I66.03 I66.09 I66.11 I66.12 I66.13 I66.19
I66.21 I66.22 I66.23 I66.29 I66.3 I66.8 I66.9
I67.841 I67.848 I67.89 M32.14 M32.15 M35.04 N05.0
N05.1 N05.2 N05.3 N05.4 N05.5 N05.6 N05.7
N05.8 N05.9 N06.0 N06.1 N06.2 N06.3 N06.4
N06.5 N06.6 N06.7 N06.8 N06.9 N07.0 N07.1
N07.2 N07.3 N07.4 N07.5 N07.6 N07.7 N07.8
N07.9 N08 N14.0 N14.1 N14.2 N14.3 N14.4
N15.0 N15.8 N15.9 N16 N17.0 N17.1 N17.2
N17.8 N17.9 N19 O09.00 O09.01 O09.02 O09.03
O09.10 O09.11 O09.12 O09.13 O09.211 O09.212 O09.213
O09.219 O09.291 O09.292 O09.293 O09.299 O09.30 O09.31
O09.32 O09.33 O09.40 O09.41 O09.42 O09.43 O09.511
O09.512 O09.513 O09.519 O09.521 O09.522 O09.523 O09.529
O09.611 O09.612 O09.613 O09.619 O09.621 O09.622 O09.623
O09.629 O09.70 O09.71 O09.72 O09.73 O09.811 O09.812
O09.813 O09.819 O09.821 O09.822 O09.823 O09.829 O09.891
O09.892 O09.893 O09.899 O09.90 O09.91 O09.92 O09.93
O36.80X0 O36.80X1 O36.80X2 O36.80X3 O36.80X4 O36.80X5 O36.80X9
R03.1 R94.31 Z13.6 Z33.1 Z34.00 Z34.01 Z34.02
Z34.03 Z34.80 Z34.81 Z34.82 Z34.83 Z34.90 Z34.91
Z34.92 Z34.93

 

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