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Coverage criteria policies

Blood pressure monitors / units - Minnesota Health Care Programs - Retire1/1/2019

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

Administrative Process

Blood pressure units do not require prior authorization.

Coverage

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

Items must be received from a contracted vendor for in-network benefits to apply.

Indications that are covered

  1. Sphygmomanometer / blood pressure apparatus with cuff and stethoscope (A4660) – Covered for recipients for whom frequent monitoring of blood pressure is medically necessary, or as part of Method II dialysis billing. Purchase only.
  2. Blood pressure cuff only – A4663 – Covered for use with recipient owned sphygmomanometer. Purchase only.
  3. Automatic blood pressure monitor – A4670 –Covered for recipients for whom frequent monitoring of blood pressure is medically necessary and who cannot accurately use a manual sphygmomanometer or as part of Method II dialysis billing. Purchase Only.

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

  • Items must be received from a contracted vendor for in-network benefits to apply.

References

  1. Department of Human Services – Medical Supply Coverage Guide

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Policy activity

  • 01/01/1998 - Date of origin
  • 08/14/2017 - Effective date
Review date
  • 05/2017
Revision date
  • 08/08/2017

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