42 state Medicaid plans now cover home BP monitoring services

Jennifer Lubell , Contributing News Writer

Eighty-four percent of all state Medicaid plans now cover (PDF) home or self-measured blood pressure (SMBP) monitoring devices. But 25 of those states go beyond covering home BP monitors to also include clinical support services such as patient education. One of those states is Michigan, which expanded Medicaid coverage to include SMBP devices and clinical services as a means of improving cardiovascular disease outcomes and increasing patient access to these devices.

Michigan Medicaid beneficiaries of any age with uncontrolled blood pressure are eligible for automated BP monitors, provided the patients meet certain criteria, such as a history of heart disease, congenital heart defects, or stroke.

Join the fight on chronic disease

AMA membership offers unique access to savings and resources tailored to enrich the personal and professional lives of physicians, residents and medical students.

Limited-time half-price dues when you join!

The AMA, which has long supported increased insurance coverage of SMBP equipment and services, is working with the Michigan State Medical Society to inform physicians about these Medicaid benefits and to encourage ordering home BP monitors for Medicaid patients, who are often economically or socially marginalized and have not been given the devices needed to measure their blood pressure. While Michigan is the first state the AMA has initiated a physician awareness campaign with the state medical society, plans are underway to work with a handful of others.

An estimated 60% of adults in the U.S. will die of cardiovascular disease such as heart attack, stroke or peripheral vascular disease. Elevated BP remains a significant risk factor for these conditions, said Melanie Manary, MD, an internist in Petoskey, Michigan, and board member of the Michigan State Medical Society. Dr. Manary is spreading awareness of SMBP coverage to doctors in Michigan.

This is important because only 30% of all patients with high BP have their condition under control. But SMBP devices, combined with ongoing clinical support, empower people about their health, Dr. Manary said.

“If you can get people to take their blood pressure reliably at home and do it the right way, with their arm at heart level, feet on the floor … you can get reasonable measurements,” she said.

Blood-pressure cuffs can cost up to $75—a price tag some patients who have been economically or socially marginalized can’t afford.

But Michigan Medicaid decided that home or self-measured devices were a reasonable, durable medical equipment benefit to cover, said Dr. Manary, noting the state will now allow patients to get a SMBP device at no cost, and reimburse physicians and other health professionals for the training associated with the monitoring, and for any follow-up activities.

This helps identify patients who didn’t previously realize they had high BP, she added.

SMBP Medicaid coverage is growing, increasing access to home BP devices and related clinical services, according to the AMA’s “SMBP Coverage Insights: Medicaid” landscape assessment (PDF) report.

In 2023, 42 states reported coverage for SMBP home devices and 36 of those also covered stand-alone SMBP cuffs, up from 38 and 31 in 2022. Meanwhile, the number of states covering Current Procedural Terminology (CPT®) code 99473—using an SMBP device validated for clinical accuracy as well as patient education or training and device calibration—expanded from 21 states in 2022 to 25 states in 2023.

This expansion in coverage has the potential to help 1.4 million Medicaid beneficiaries with hypertension across the U.S.  

But many physicians in Michigan still don’t know this is a covered benefit under Medicaid. That is why Dr. Manary has been trying to get the word out through committee meetings with physician organizations and social media. 

Physician practices can tell patients how to order these devices—what to put on the prescription form and that the code for ordering them is benign hypertension. They can also coach patients on how to identify their durable medical equipment provider, which is sometimes hard to figure out.

Insurance policies vary among patients, said Dr. Manary. And prior authorization is sometimes required, depending on the patient’s Medicaid coverage. Physicians can reference this comprehensive guide on prescribing SMBP for Michigan Medicaid patients (PDF) to get more details.

One way to avoid prior authorization is to choose the health plan’s preferred durable medical equipment provider, she suggested.

Getting paid for SMBP services as a physician in Michigan is relatively easy. There are just two codes: one for prescribing it, and the other for going over results with patients. But if you're a doctor in a rural health clinic, you can't get paid for prescribing it. You can get paid if you use another E/M code for when the patient comes back in, said Dr. Manary.

Learn more with the AMA about self-measured blood pressure benefits for patients with Medicaid in Michigan.