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6.3.20 Diagnostic Tests
6.3.20.1 Ambulatory Blood Pressure Monitoring
Ambulatory blood pressure monitoring is a covered benefit for patients when hypertension is suspected but not defined by history or physical. Ambulatory blood pressure monitoring has been shown to be effective when used in the differential diagnosis of hypertension not elucidated by conventional studies.
Benefits are limited to the following medical necessities:
• Blood pressure measurements taken in the clinic or office are greater than 140/90 mm Hg on at least three separate visits, with two separate measurements made at each visit.
•At least two separately documented blood pressure measurements taken outside of the clinic or office that are less than 140/90 mm Hg.
•There is no evidence of end-organ damage.
Indications for the use of this monitoring are for diagnostic purposes only and should not be used for maintenance monitoring.
Use procedure codes 93784, 93786, 93788, and/or 93790 to bill in 24-hour increments for ambulatory blood pressure monitoring. Ambulatory blood pressure monitoring is a benefit when submitted with diagnosis code 7962.
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