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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.6 Durable Medical Equipment (DME) Supplier (CCP) : 2.6.4 Blood Pressure Devices

2.6.4
2.6.4.1
The following blood pressure devices and their components are benefits of CCP in the home setting for self-monitoring when the equipment is prescribed by a physician:
Manual blood pressure device. A device that requires manual cuff inflation with real-time visualization of the results displayed on the manometer.
Automated blood pressure device. A device that inflates the cuff manually or automatically and displays the blood pressure results on a small screen.
Note:
Hospital-grade blood pressure device. A device that includes memory for continuous recording, has an alarm system to notify the caregiver of abnormal readings, and is capable of frequent or continuous automatic blood pressure and heart rate monitoring with correction of motion artifact.
Documentation that supports medical necessity of the requested equipment, including the diagnosis, must be maintained in the client’s medical record and is subject to retrospective review.
Refer to:
Subsection 9.2.26.1, “Ambulatory Blood Pressure Monitoring” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for information about ambulatory blood pressure devices.
2.6.4.1.1
Providers must use procedure code A4660 or A4670 when billing for manual or automated blood pressure devices.
Manual and automated blood pressure devices that have been purchased are anticipated to last a minimum of one year and may be considered for replacement when one year has passed or when the equipment is not functional and not repairable.
Manual and automated blood pressure devices may be reimbursed when billed with one of the following diagnosis codes:
 
2.6.4.1.2
Providers must use procedure code A9279 with modifier U1 when billing for hospital-grade blood pressure devices.
Hospital-grade blood pressure devices that have been purchased are anticipated to last a minimum of three years and may be considered for replacement when three years have passed or when the equipment is not functional and not repairable.
For clients who are birth through 11 months of age, the rental or purchase of a hospital-grade blood pressure device is a benefit when documentation supports medical necessity and includes an explanation of why the client cannot use a standard automated blood pressure device.
For clients who are 12 months of age and older, the rental or purchase of a hospital-grade blood pressure device is a benefit on a case-by-case basis. Supporting documentation of medical necessity must be provided.
The following indications are recognized by Texas Medicaid for hospital-grade blood pressure devices:
All rental costs of the hospital-grade blood pressure device apply toward the purchase price.
2.6.4.1.3
The following may be considered for reimbursement of blood pressure device:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.