[from AMA Advocacy Update]

Responding to a joint request from the AMA and the American Heart Association (AHA), the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination expanding covered indications for the use of ambulatory blood pressure monitoring (ABPM) in diagnosing hypertension to include suspected masked hypertension, where in-office blood pressure readings may be lower than those taken elsewhere. Previously, Medicare covered ABPM for suspected white coat hypertension, when in-office blood pressure is higher than when measured at home, but not for masked hypertension, such as for patients whose blood pressure is normal in the clinic but above normal out of the clinic or at night.

As the AMA and AHA urged in a joint comment letter on the proposed coverage decision, CMS made important modifications to the final ABPM policy:

• Updated systolic and diastolic blood pressure readings that qualify for ABPM coverage to reflect the 2017 AHA/American College of Cardiology guidelines
• Removed the requirement for lifestyle interventions prior to ABPM use
• Specified detection of nocturnal hypertension as a covered indication for ABPM use

Expanded Medicare coverage of ABPM is consistent with recommendations of the U.S. Preventive Services Task Force and represents a major advance in physicians' ability to appropriately diagnose hypertension, which can have serious consequences for patients' health without appropriate diagnosis and management.

More information on AMA and AHA tools for controlling hypertension is available here.