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 (
Section 2.1)
when prescribed for a patient who is also receiving covered Remote
Physiologic Monitoring (RPM) services, as described in
Chapter 2, Section 7.1, for medically necessary
blood pressure monitoring.
2.2 All DME
coverage, reimbursement, and cost-sharing requirements apply.
2.4 Coverage
for infantile apnea cardiorespiratory monitors is provided in
Section 2.2.
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
Section 2.1, paragraph 5.10.