CSHCN Services Program 2010 > Blood Pressure Devices and Supplies > Benefits, Limitations, and Authorization Requirements

   
 

11.2 Benefits, Limitations, and Authorization Requirements

11.2.1 Blood Pressure Devices

Blood pressure monitoring devices are benefits of the CSHCN Services Program when they are prescribed by a physician. The rental (procedure code E1399) or purchase (procedure code A4660 or A4670) of blood pressure monitoring devices may be considered when submitted with one of the diagnosis codes in the following table. Providers must maintain documentation in the client's medical record to support medical necessity.

Diagnosis Code
Description
4010
Essential hypertension, malignant
4011
Essential hypertension, benign
4019
Unspecified essential hypertension
40200
Malignant hypertensive heart disease without heart failure
40201
Malignant hypertensive heart disease with heart failure
40210
Benign hypertensive heart disease without heart failure
40211
Benign hypertensive heart disease with heart failure
40290
Unspecified hypertensive heart disease without heart failure
40291
Unspecified hypertensive heart disease with heart failure
40300
Hypertensive kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified
40301
Hypertensive kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease
40310
Hypertensive kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified
40311
Hypertensive kidney disease, benign, with chronic kidney disease stage V or end stage renal disease
40390
Hypertensive kidney disease, unspecified, without chronic kidney disease with chronic kidney disease stage I through stage IV, or unspecified
40391
Hypertensive kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease
40400
Hypertensive heart and kidney disease, malignant, without heart failure or chronic kidney disease stage I through stage IV, or unspecified
40401
Hypertensive heart and kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
40402
Hypertensive heart and kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease
40403
Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease stage V or end stage renal disease
40410
Hypertensive heart and kidney disease, benign, without heart failure or chronic kidney disease stage I through stage IV, or unspecified
40411
Hypertensive heart and kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified
40412
Hypertensive heart and kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease
40413
Hypertensive heart and kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease
40490
Hypertensive heart and kidney disease, unspecified, without heart failure or chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified
40491
Hypertensive heart and kidney disease, unspecified, with heart failure stage I through stage IV, or unspecified
40492
Hypertensive heart and kidney disease, unspecified, with chronic kidney
disease stage V or end stage renal disease
40493
Hypertensive heart and kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease
40501
Secondary renovascular hypertension, malignant
40509
Other secondary hypertension, malignant
40511
Secondary renovascular hypertension, benign
40519
Other secondary hypertension, benign
40591
Secondary renovascular hypertension, unspecified
40599
Other secondary hypertension, unspecified
41411
Aneurysm of coronary vessels
4142
Chronic total occlusion of coronary artery
4150
Acute cor pulmonale
41511
Iatrogenic pulmonary embolism and infarction
41512
Septic pulmonary embolism
41519
Other pulmonary embolism and infarction
4160
Primary pulmonary hypertension
4161
Kyphoscoliotic heart disease
4162
Chronic pulmonary embolism
4168
Other chronic pulmonary heart diseases
4169
Unspecified chronic pulmonary heart disease
4240
Mitral valve disorders
4241
Aortic valve disorders
4242
Tricuspid valve disorders, specified as nonrheumatic
4243
Pulmonary valve disorders
42490
Endocarditis, valve unspecified, unspecified cause
42491
Endocarditis in diseases classified elsewhere
42499
Other endocarditis, valve unspecified
4250
Endomyocardial fibrosis
4251
Hypertrophic obstructive cardiomyopathy
4253
Endocardial fibroelastosis
4254
Other primary cardiomyopathies
4260
Atrioventricular block, complete
42610
Unspecified atrioventricular block
42611
First degree atrioventricular block
42612
Mobitz (type) II atrioventricular block
42613
Other second-degree atrioventricular block
4262
Left bundle branch hemiblock
4263
Other left bundle branch block
4264
Right bundle branch block
42650
Unspecified bundle branch block
42651
Right bundle branch block and left posterior fascicular block
42652
Right bundle branch block and left anterior fascicular block
42653
Other bilateral bundle branch block
4266
Other heart block
42681
Lown-Ganong-Levine syndrome
42689
Other specified conduction disorders
4269
Unspecified conduction disorder
4270
Paroxysmal supraventricular tachycardia
4271
Paroxysmal ventricular tachycardia
4272
Unspecified paroxysmal tachycardia
42731
Atrial fibrillation
42732
Atrial flutter
42781
Sinoatrial node dysfunction
4280
Congestive heart failure, unspecified
4281
Left heart failure
42820
Unspecified systolic heart failure
42821
Acute systolic heart failure
42822
Chronic systolic heart failure
42823
Acute on chronic systolic heart failure
42830
Unspecified diastolic heart failure
42831
Acute diastolic heart failure
42832
Chronic diastolic heart failure
42833
Acute on chronic diastolic heart failure
42840
Unspecified combined systolic and diastolic heart failure
42841
Acute combined systolic and diastolic heart failure
42842
Chronic combined systolic and diastolic heart failure
42843
Acute on chronic combined systolic and diastolic heart failure
4289
Unspecified heart failure
5800
Acute glomerulonephritis with lesion of proliferative glomerulonephritis
5804
Acute glomerulonephritis with lesion of rapidly progressive glomerulonephritis
58081
Acute glomerulonephritis with other specified pathological lesion in kidney in disease classified elsewhere
58089
Acute glomerulonephritis with other specified pathological lesion in kidney
5809
Acute glomerulonephritis with unspecified pathological lesion in kidney
5810
Nephrotic syndrome with lesion of proliferative glomerulonephritis
5811
Nephrotic syndrome with lesion of membranous glomerulonephritis
5812
Nephrotic syndrome with lesion of membranoproliferative glomerulonephritis
5813
Nephrotic syndrome with lesion of minimal change glomerulonephritis
58181
Nephrotic syndrome with other specified pathological lesion in kidney in diseases classified elsewhere
58189
Other nephrotic syndrome with specified pathological lesion in kidney
5819
Nephrotic syndrome with unspecified pathological lesion in kidney
5820
Chronic glomerulonephritis with lesion of proliferative glomerulonephritis
5821
Chronic glomerulonephritis with lesion of membranous glomerulonephritis
5822
Chronic glomerulonephritis with lesion of membranoproliferative
glomerulonephritis
5824
Chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis
58281
Chronic glomerulonephritis in diseases classified elsewhere
58289
Other chronic glomerulonephritis with specified pathological lesion in kidney in diseases classified elsewhere
5829
Chronic glomerulonephritis with unspecified pathological lesion in kidney
5830
Nephritis and nephropathy, not specified as acute or chronic, with lesion of proliferative glomerulonephritis
5831
Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranous glomerulonephritis
5832
Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranoproliferative glomerulonephritis
5834
Nephritis and nephropathy, not specified as acute or chronic, with lesion of rapidly progressive glomerulonephritis
5836
Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal cortical necrosis
5837
Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal medullary necrosis
58381
Nephritis and nephropathy, not specified as acute or chronic, with other specified pathological lesion in kidney, in diseases classified elsewhere
58389
Other nephritis and nephropathy, not specified as acute or chronic, with specified pathological lesion in kidney
5839
Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney
5845
Acute kidney failure with lesion of tubular necrosis
5846
Acute kidney failure with lesion of renal cortical necrosis
5847
Acute kidney failure with lesion of renal medullary (papillary) necrosis
5848
Acute kidney failure with other specified pathological lesion in kidney
5849
Unspecified acute renal failure
5851
Chronic kidney disease, Stage I
5852
Chronic kidney disease, Stage II (mild)
5853
Chronic kidney disease, Stage III (moderate)
5854
Chronic kidney disease, Stage IV (severe)
5855
Chronic kidney disease, Stage V
5856
End-stage renal disease
5859
Chronic kidney disease, unspecified
586
Unspecified renal failure
587
Unspecified renal sclerosis
5880
Renal osteodystrophy
5881
Nephrogenic diabetes insipidus
58881
Secondary hyperparathyroidism (of renal origin)
58889
Other specified disorders resulting from impaired renal function
5889
Unspecified disorder resulting from impaired renal function
5890
Unilateral small kidney
5891
Bilateral small kidneys
5899
Unspecified small kidney
59000
Chronic pyelonephritis without lesion of renal medullary necrosis
59001
Chronic pyelonephritis with lesion of renal medullary necrosis
59010
Acute pyelonephritis without lesion of renal medullary necrosis
59011
Acute pyelonephritis with lesion of renal medullary necrosis
5902
Renal and perinephric abscess
5903
Pyeloureteritis cystica
59080
Unspecified pyelonephritis, unspecified
59081
Pyelitis or pyelonephritis in diseases classified elsewhere
5909
Infection of kidney, unspecified
591
Hydronephrosis
59371
Vesicoureteral reflux with reflux nephropathy, unilateral
59372
Vesicoureteral reflux with reflux nephropathy, bilateral
59373
Other vesicoureteral reflux with reflux nephropathy NOS
7450
Bulbus cordis anomalies and anomalies of cardiac septal closure, common truncus
74510
Complete transposition of great vessels
74511
Transposition of great vessels, double outlet right ventricle
74512
Corrected transposition of great vessels
74519
Other transposition of great vessels
7452
Tetralogy of Fallot
7453
Bulbus cordis anomalies and anomalies of cardiac septal closure, common ventricle
7454
Ventricular septal defect
7455
Ostium secundum type atrial septal defect
74560
Unspecified type congenital endocardial cushion defect
74561
Ostium primum defect
74569
Other congenital endocardial cushion defects
7457
Cor biloculare


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