Remind Members to Self-Monitor Blood Pressure

We ask that you remind our members with hypertension that EmblemHealth covers automatic blood pressure monitors. There is no member cost-share or preauthorization requirement for members diagnosed with hypertension, provided they meet these coverage criteria.* 

Please discuss how self-monitoring at home may help 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. This initiative can also help support your blood pressure data capture and the management of your patients, and improve your performance rate for the Quality measure: Controlling Blood Pressure.

Here are recommended steps you can take to help members 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 it is 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 improveperformance rate. Adequate control required to meet compliance: BP <140/90 Hg.
   
   1. 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
      
      
   2. 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 on self-monitoring tools and protocols, the CDC has educational materials for members to support Self-Measured Blood Pressure Monitoring | Million Hearts® (hhs.gov).

    

   *This is an EmblemHealth benefit only for members diagnosed with hypertension.