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HealthPartners

Coverage criteria policies

Blood pressure monitors/units – Retire1/1/2019

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative Process

Manual and digital self-inflating blood pressure units do not require prior authorization.

Electrical automated blood pressure units (such as Dinamap) require prior authorization.

For in-network benefits to apply, either unit or monitor must be received from a contracted vendor or provider.

Coverage

Generally covered subject to the indications listed below and following limits from your member contract:

For in-network benefits to apply, item must be received from a contracted vendor or provider.

Indications that are covered

Blood pressure monitors are generally covered subject to the indications listed below, and per your plan documents.

  1. Manual or digital blood pressure units are covered for members who have undergone a transplant procedure or are receiving kidney dialysis. This is a purchase item only.
  2. Electrical automated blood pressure monitors (such as Dinamap) are eligible for coverage only for members who meet the criteria for a manual blood pressure unit AND require continuous blood pressure readings, AND for whom it is physically impossible to take a manual reading. An example is an infant who is too small for a manual cuff. This item is on a rental basis only.

Indications that are not covered

  1. Blood pressure units are not covered in the absence of a transplant or dialysis condition.
  2. Wrist blood pressure units.
  3. Blood pressure units with printers.
  4. Other deluxe or non-standard blood pressure units.

Definitions

  1. Manual blood pressure units (A4660 - sphygmomanometer with stethoscope) have an aneroid sphygmomanometer with a stethoscope and blood pressure cuff in the traditional style. This item is available for purchase only, and does not require prior authorization.
  2. Automatic blood pressure units (A4670 - automatic BP monitor) describes 2 distinct devices:
    1. Digital blood pressure unit has a battery operated, self-inflating arm cuff with a digital readout and basic test memory. This item is available for purchase only, and does not require prior authorization.
    2. Electrical automated oscillometer blood pressure unit (such as Dinamap) is an appliance with a cuff attachment that automatically reads the blood pressure and pulse at preset or programmed intervals. This item is available on a monthly rental basis only, and requires prior authorization.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

A4660

Sphygmomanometer/blood pressure apparatus with cuff and stethoscope

A4663

Blood pressure cuff only

A4670

Automatic blood pressure monitor

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

For in-network benefits to apply, item must be received from a contracted vendor or provider.

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Policy activity

  • 01/01/1998 - Date of origin
  • 08/01/2017 - Effective date
Review date
  • 05/2017
Revision date
  • 07/12/2017

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