EmblemHealth covers automatic blood pressure monitors—with no member cost-share or preauthorization requirement—for its members diagnosed with hypertension, provided they meet these coverage criteria.*
We encourage you to prescribe a digital device for these members and discuss how self-monitoring at home may help them lower their blood pressure. Members can report their blood pressure verbally during a telehealth (telephone, e-visit, virtual) or office visit.
This is a HEDIS® measure and this initiative can help support your blood pressure data capture, assist with management of your patients, and improve your performance rate for the Quality measure: Controlling Blood Pressure.
Here are the recommended steps you can take to help your patients with hypertension:
- Encourage patients to monitor their blood pressure at home using a digital at-home device.
- Place an order for a blood pressure monitor ONLY through any EmblemHealth-contracted Pharmacy or contracted DME provider. The cost of the device cannot exceed $40.
- Clearly document in the Medical Record that the reading was taken by a digital device and the date it was taken. Blood pressure readings taken by a patient using a non-digital device (e.g., manual blood pressure, stethoscope) do not meet criteria. Electronic submission from the device is not required, though recommended.
These codes are required for Quality care gap closure:
1. CPT II Code Submission: Submit CPT II codes to reflect the results of the BP reading and improve performance rate. Adequate control required to meet compliance: BP <140/90 Hg.
a. Systolic Blood Pressure CPT II:
3074F – blood pressure less than 130 mmHg
3075F – blood pressure 130-139 mmHg
3077F – blood pressure greater than or equal to 140 mmHg
b. Diastolic Blood Pressure CPT II:
3078F – blood pressure less than 80 mmHg
3079F – blood pressure 80-89 mmHg
3080F – blood pressure greater than or equal to 90
For more information, the CDC has educational materials to hand out to members to support Self-Measured Blood Pressure Monitoring | Million Hearts® (hhs.gov)
*This is an EmblemHealth benefit only for members diagnosed with hypertension
