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    v1.0.30
    OpenPayerPolicy UpdatesClinical/Medical PolicyDHA Automatic Blood Pressure Coverage | OpenPayer
    Ask Trek AI about this page
    CurrentDHAPolicy 6010.60-M

    Automatic Blood Pressure Monitors

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    This policy addresses blood pressure monitors as durable medical equipment within the DHA Policy Manual.

    Policy Summary
    PayerDHA
    PolicyAutomatic Blood Pressure Monitors
    Policy CodePolicy 6010.60-M
    Change TypeNo material change
    Effective DateJune 29, 2023
    Next Review DateNot specified
    Key ActionVerify that the monitor meets durable medical equipment criteria and that the patient receives covered remote physiologic monitoring for blood pressure.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Covered with criteriaCoverage stance
    RPM requiredRemote monitoring
    ExcludedManual monitors
    RestrictedESRD reimbursement

    Blood Pressure Monitor Coverage

    Automatic Blood Pressure Monitor Coverage

    Automatic blood pressure monitors may be covered when ALL of the following criteria are met:

    ALL of the following

    • The monitor is an automatic blood pressure monitor, also known as a digital or oscillometric sphygmomanometer, that uses oscillometric measurements to assess blood pressure.
    • The monitor is prescribed for medically necessary blood pressure monitoring.
    • The patient is receiving covered Remote Physiologic Monitoring (RPM) services for blood pressure monitoring.
    • The monitor meets TRICARE's definition and coverage requirements for Durable Medical Equipment (DME).

      All DME coverage, reimbursement, and cost-sharing requirements apply.

    Policy Summary
    PayerDHA
    PolicyAutomatic Blood Pressure Monitors
    Policy CodePolicy 6010.60-M
    Change TypeNo material change
    Effective DateJune 29, 2023
    Next Review DateNot specified
    Key ActionVerify that the monitor meets durable medical equipment criteria and that the patient receives covered remote physiologic monitoring for blood pressure.
    SourceLink
    On This Page
    Blood Pressure Monitor CoverageProvider and Reimbursement ConsiderationsBlood Pressure Monitoring OverviewKey Terms

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Automatic blood pressure monitors that do not meet the TRICARE Program's definition or coverage requirements for Durable Medical Equipment (DME) are excluded from coverage. All applicable DME coverage, reimbursement, and cost-sharing requirements apply.

    Automatic blood pressure monitors are excluded when the patient is not receiving covered Remote Physiologic Monitoring (RPM) services for blood pressure monitoring.

    Manual blood pressure monitors are excluded from coverage.

    Automatic blood pressure monitors are not separately reimbursable for patients diagnosed with End Stage Renal Disease (ESRD) when an ESRD facility prescribes the monitor for reasons related to ESRD treatment. ESRD facilities are responsible for, and reimbursed for, furnishing all supplies as part of the ESRD reimbursement amount.

    This restriction does not affect TRICARE coverage of automatic blood pressure monitors for ESRD patients. Separate reimbursement is permitted when the monitor is prescribed by a provider other than an ESRD facility, provided all coverage criteria are met. The contractor must ensure that beneficiaries do not receive duplicate equipment.

    Provider and Reimbursement Considerations

    Denial Risk

    Monitor or RPM Requirements Not Met

    Claims are at risk of denial when an automatic blood pressure monitor does not meet the TRICARE Program’s DME definition or coverage requirements, or when the patient is not receiving covered RPM services for blood pressure monitoring. Manual blood pressure monitors are excluded from coverage.

    • Confirm the monitor meets TRICARE DME definition and coverage requirements.
    • Confirm the patient is receiving covered RPM services for blood pressure monitoring.
    Billing Rule

    ESRD Separate Reimbursement Restriction

    Automatic blood pressure monitors are not separately reimbursable for patients diagnosed with ESRD when an ESRD facility prescribes the monitor for reasons related to ESRD treatment, because ESRD facilities are responsible for furnishing supplies within the ESRD reimbursement amount. This restriction does not eliminate TRICARE coverage for ESRD patients; separate reimbursement is permitted when a non-ESRD-facility provider prescribes the monitor and all coverage criteria are met.

    • Do not separately reimburse an automatic blood pressure monitor prescribed by an ESRD facility for ESRD treatment-related reasons.
    • For ESRD patients, verify the prescribing provider is not an ESRD facility when seeking separate reimbursement and confirm all coverage criteria are met.
    • Prevent duplicate equipment in accordance with Chapter 8, Section 2.1, paragraph 5.10.

    Blood Pressure Monitoring Overview

    Automatic blood pressure monitors, also called digital or oscillometric sphygmomanometers, use oscillometric measurements to assess a patient’s blood pressure. Blood pressure measurement supports the detection, monitoring, and treatment of hypertension or hypotension, including conditions associated with either disorder.

    Key Terms

    Automatic blood pressure monitor
    DefinitionAn automatic blood pressure monitor assesses a patient’s blood pressure using oscillometric measurements.
    Digital terminologyThe device is also known as a digital sphygmomanometer.
    Oscillometric terminologyThe device is also known as an oscillometric sphygmomanometer.
    Use settingThe monitor may be used by a provider in a clinical setting or by the patient.
    Self-measured blood pressure monitoring
    DefinitionSelf-measured blood pressure monitoring is blood pressure monitoring performed by the patient rather than by a provider in a clinical setting.
    Person performing measurementThe patient performs the blood pressure measurement.
    Clinical distinctionSelf-measured monitoring differs from blood pressure measurement performed by a provider in a clinical setting.