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.
2.0 POLICY
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.
3.0 EXCLUSIONS
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.