Annual landscape assessment provides snapshot of SMBP Medicaid coverage
The SMBP Coverage Insights: Medicaid landscape assessment (PDF) is compiled and published annually by the Improving Health Outcomes (IHO) group at the AMA, and highlights the progress made in increasing Medicaid coverage for self-measured blood pressure (SMBP) devices and related clinical services. The report specifies states that have expanded coverage for SMBP services and devices, and those where there are still gaps to address.
In 2023, 42 states reported coverage for SMBP home devices and 36 of those also covered standalone SMBP cuffs, up from 38 and 31 in 2022. This expansion in coverage has the potential to impact 1.4 million Medicaid beneficiaries across the U.S. with hypertension.
The data is researched and compiled from publicly available state Medicaid fee schedules, provider manuals and pertinent bulletins, with coverage identified and documented by specifying the following CPT® and HCPCS codes:
- 99473: SMBP using a device validated for clinical accuracy; patient education/training and device calibration
- 99474: Separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient
- A4670: Automatic blood pressure monitor
- A4663: Blood pressure cuff
In addition to the home BP device, providing SMBP clinical services is essential to managing hypertension. The report points to the upward trend in states covering CPT codes 99473 and 99474, which have only been available since Jan. 1, 2020. In 2022, 21 states provided payment for 99473, and 18 states for 99474. In 2023, that number expanded to 25 states providing payment for 99473, and 22 states for 99474.
The findings in the report (PDF) reveal promising progress toward increasing access to SMBP devices and related clinical services for Medicaid beneficiaries. With more states adopting comprehensive SMBP coverage policies, this annual landscape assessment serves as a vital resource for policymakers, health care providers and medical society staff in advocating for equitable SMBP access.
More articles in this issue
- April 5, 2024: Advocacy Update spotlight on opposed scope of practice expansion
- April 5, 2024: Medicare Payment Reform Advocacy Update
- April 5, 2024: National Advocacy Update
