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TRICARE Policy Manual 6010.60-M, April 1, 2015
Other Services
Chapter 8
Section 2.8
Blood Pressure Monitors
Issue Date:  November 8, 2023
Revision:  C-120, November 8, 2023
1.0  Description
1.1  An automatic blood pressure monitor, also known as a digital or oscillometric sphygmomanometer, uses oscillometric measurements to assess a patient’s blood pressure. They may be used by a provider in a clinical setting or by a patient, which is referred to as self-measured blood pressure monitoring.
1.2  Blood pressure measurements are used to detect, monitor, and assist in the treatment of hypertension or hypotension, which may occur due to underlying health conditions, medications, lifestyle factors, pregnancy, ethnicity, and/or age. Uncontrolled hypertension and hypotension may be symptoms of serious health conditions and are significant risk factors for chronic kidney disease, myocardial infarction, congestive heart failure, and stroke. Blood pressure measurements are also used by providers for the clinical management of conditions associated with hypertension or hypotension.
2.1  Automatic blood pressure monitors may be covered under TRICARE’s Durable Medical Equipment (DME) policy (Chapter 8, Section 2.1) when prescribed for a patient who is also receiving covered Remote Physiologic Monitoring (RPM) services, as described in Chapter 2, Section 8.1, for medically necessary blood pressure monitoring.
2.2  All DME coverage, reimbursement, and cost-sharing requirements apply.
2.3  Coverage for ambulatory blood pressure monitoring is provided in Chapter 4, Section 9.1, paragraph 3.8.
2.4  Coverage for infantile apnea cardiorespiratory monitors is provided in Chapter 8, Section 2.2.
3.1  Automatic blood pressure monitors that do not meet the TRICARE Program’s definition or coverage requirements for DME.
3.2  Automatic blood pressure monitors for patients not receiving covered RPM services for blood pressure monitoring.
3.3  Manual blood pressure monitors are excluded from coverage.
3.4  Automatic blood pressure monitors are not separately reimbursable for patients diagnosed with End Stage Renal Disease (ESRD) when an ESRD facility prescribes the blood pressure monitor for reasons related to the ESRD treatment, as ESRD facilities are responsible and reimbursed for furnishing all supplies as part of the ESRD reimbursement amount. This does not impact TRICARE coverage of automatic blood pressure monitors for ESRD patients. Separate reimbursement of automatic blood pressure monitors is permitted for patients with ESRD when prescribed by a provider other than an ESRD facility if all coverage criteria are met. The contractor shall ensure that beneficiaries do not receive duplicate equipment, per Chapter 8, Section 2.1, paragraph 5.10.
Coverage of automatic blood pressure monitors is effective June 29, 2023.
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