What is self-measured blood pressure (SMBP) monitoring?
Self-measured blood pressure (SMBP) monitoring, the regular measurement of blood pressure (BP) by the patient outside the clinical setting, either at home or elsewhere, is a validated approach for out-of-office BP measurement.
Why is it important?
Improving the diagnosis, treatment, and control of the hypertension is critical for achieving the American Heart Association’s impact goals and improving the cardiovascular health of all Americans. Of the 116.4 million American adults estimated to have hypertension, nearly half do not have the condition under control, with many cases going undiagnosed. The diagnosis and management of hypertension has been primarily based on the measurement of BP in the office, however BP may differ considerably when measured in the office versus outside of the office setting.
Is SMBP equipment covered in Kentucky?
Yes! As part of the Durable Medical Equipment fee schedule, SMBP cuffs for the patient to use at home are now covered for Medicaid recipients. CPT® codes for SMBP are available and can be submitted for services related to patient training on SMBP, interpretation of SMBP measurements and management based on results.
As clarification, the following two codes were previously covered:
99473-SMBP using a device validated for clinical accuracy and patient education/training and device calibration.
99474-Separate self-measurements, collection of daily reports by the patient or caregiver to the healthcare provider, communication of BP readings and treatment plans.
And now, as of 2/8/2023, the following two codes are also covered in Kentucky:
A4670 -Automated blood pressure device
A4663-Blood pressure cuff only
Here are the 7 steps you and your patient can take for SMBP monitoring:
1. Identify patients for SMBP
- Patients with an existing diagnosis of hypertension
- Patients with high blood pressure without a diagnosis of hypertension
- Patients suspected of having hypertension (labile or masked hypertension)
2. Confirm device validation and cuff size
- Make sure patients have automated, validated devices with appropriately sized upper arm cuffs
Tools: Use the US Blood Pressure Validated Device Listing™ and Self-measured blood pressure cuff selection
3. Train patients
- Educate patients on how to perform SMBP using an evidence-based measurement protocol
- Education should include proper preparation and positioning before taking measurements, as well as resting one minute between measurements
- Verify patients’ understanding and share educational resources
Tools: Use the SMBP training video (see also: Spanish version) and the SMBP infographic (see also: Spanish version)
4. Have patients perform SMBP and relay results
- Conduct SMBP monitoring whenever BP assessment is desired (e.g., to confirm a diagnosis, to assess every 2-4 weeks if BP is uncontrolled or at physician discretion)
- Provide instructions on the duration of monitoring and the number of measurements to take each day
- 7 days of monitoring recommended; 3 days (i.e., 12 readings) minimum
- Measurements should be taken twice daily (morning and evening) with at least two measurements taken each time
- Determine when and how patients will share results back to care team
- Examples include phone, portal or secure messaging
Tool: Use the SMBP recording log
5. Average results
- Average all SMBP measurements received from patients for monitoring period
- Document average systolic and average diastolic blood pressure in medical record
- Use the average systolic and average diastolic blood pressure for clinical decision making
- 3 days of measurements (i.e., 12 readings) are recommended as a minimum for clinical decision-making
Tool: Use the SMBP averaging tool
6. Interpret results
- Make diagnosis and/or assess control
- Initiate, intensify or continue treatment as needed
Tool: Use the SMBP interpretation tables
7. Document plans and communicate to patients
- Document treatment and follow-up plans and communicate to patients
- Confirm patients’ agreement and understanding
Where/how should patients get their SMBP device/cuff?
You, as a provider, will write out a prescription for the device or cuff. The patient will then take that order to their Medicaid-approved DME supplier of choice.
Which patients should be prescribed SMBP devices/cuffs?
Requirements pertaining to SMBP can be found on the American Medical Association (AMA) website here:
