Corporate Medical Policy Ambulatory Blood Pressure Monitoring
|
|
- Mitchell Armstrong
- 7 years ago
- Views:
Transcription
1 Corporate Medical Policy Ambulatory Blood Pressure Monitoring File Name: Origination: Last CAP Review: Next CAP Review: Last Review: ambulatory_blood_pressure_monitoring 7/1982 4/2016 4/2017 4/2016 Description of Procedure or Service Ambulatory blood pressure monitors (24-hour sphygmomanometers) are portable devices that record blood pressure repeatedly while the patient is involved in daily activities. There are various types of ambulatory monitors; this policy addresses fully automated monitors, which inflate and record blood pressure at pre-programmed intervals. Ambulatory blood pressure monitoring (ABPM), typically done over a 24-hour period with a fully automated monitor, provides more detailed blood pressure information than typically obtained during office visits. The greater number of readings with ABPM ameliorates the variability of single blood pressure measurements, and is more representative of the circadian rhythm of blood pressure compared to the limited number obtained during office measurement. There are a number of potential applications of ABPM. One of the most common is evaluating suspected white-coat hypertension (WCH), which is defined as an elevated office blood pressure with normal blood pressure readings outside the physician s office. The etiology of WCH is poorly understood but may be related to an alerting" or anxiety reaction associated with visiting the physician's office. In evaluating patients having elevated office blood pressure, ABPM is often intended to identify patients with normal ambulatory readings who do not have sustained hypertension. Since this group of patients would otherwise be treated based on office blood pressure readings alone, ABPM could improve outcomes by allowing these patients to avoid unnecessary treatment. However, this assumes patients with WCH are not at increased risk for cardiovascular events and would not benefit from antihypertensive treatment. This policy does not directly address other uses of ABPM, including the use of ABPM for the evaluation of masked hypertension. Masked hypertension refers to normal BP readings in the office and elevated BP readings outside of the office. This phenomenon has recently received greater attention, with estimates that up to 10-20% of individuals may exhibit this pattern. Many ambulatory blood pressure monitors have received clearance to market through the U.S. Food and Drug Administration (FDA) 510(k) marketing clearance process. As an example of an FDA indication for use, the Welch Allyn ABPM 6100 is indicated as an aid or adjunct to diagnosis and treatment when it is necessary to measure adult or pediatric patients systolic and diastolic blood pressures over an extended period of time. The system is only for measurement, recording, and display. It makes no diagnosis. ***Note: This Medical Policy is complex and technical. For questions concerning the technical language and/or specific clinical indications for its use, please consult your physician. Policy Page 1 of 6
2 BCBSNC will provide coverage for Ambulatory Blood Pressure Monitoring when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Benefits Application This medical policy relates only to the services or supplies described herein. Please refer to the Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore member benefit language should be reviewed before applying the terms of this medical policy. When Ambulatory Blood Pressure Monitoring is covered Automated ambulatory blood pressure monitoring over a 24-hour period may be considered medically necessary: To differentiate between white coat hypertension or other symptoms/findings inconsistent with in office blood pressure readings and true hypertension; or To monitor for suspected Episodic Hypertension (e.g. Pheochromocytoma); or To monitor for hypertension resistant to increasing medications; or To monitor for hypotensive symptoms while taking antihypertensive medications; or To monitor for autonomic dysfunction; or To evaluate whether antihypertensive therapy is moderating the early morning blood pressure surge. When Ambulatory Blood Pressure Monitoring it is not covered Ambulatory Blood Pressure Monitoring is considered not medically necessary when the medical criteria listed above are not met. Ambulatory blood pressure monitoring in patients who have not tried conventional intermittent home blood pressure monitoring is considered not medically necessary. Ambulatory blood pressure monitoring for patients with elevated office BP is considered not medically necessary, including but not limited to repeat testing in patients with persistently elevated office BP. Ambulatory blood pressure monitoring to screen for hypertension is considered not medically necessary. Policy Guidelines Ambulatory blood pressure monitoring (ABPM) performed over a 24-hour period is a more accurate method for evaluating blood pressure (BP) compared with office measurements and home BP measurements. Reference values for normal and abnormal ABPM results have been derived from epidemiologic research for both adults and children. These reference values vary slightly among different sources but are available for clinical use. Data from large prospective cohort studies establish that ABPM correlates more strongly with cardiovascular outcomes compared with other methods of BP measurement. Prospective cohort studies also indicate that white coat hypertension (WCH), as defined by ABPM, is associated with an intermediate risk of cardiovascular outcomes compared with normotensive and hypertensive patients. Studies comparing home BP monitoring and office monitoring to ABPM as the criterion standard report that the sensitivity and specificity of alternative methods of diagnosing hypertension are suboptimal. This is true for both adult and pediatric patients. Substantial percentages of patients Page 2 of 6
3 with elevated office BP are found to have normal BP on ABPM, and these patients are at risk for over diagnosis and overtreatment based on office BP measurements alone. Use of ABPM in these patients will improve outcomes by eliminating the inconvenience and morbidity of pharmacologic treatment in patients who are not expected to benefit. Billing/Coding/Physician Documentation Information This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at They are listed in the Category Search on the Medical Policy search page. Applicable codes: 93784, 93786, 93788, BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included. Scientific Background and Reference Sources BCBSA Medical Policy Reference Manual - 12/95 Medical Policy Advisory Group - 1/99 Specialty Matched Consultant Advisory Panel - 8/2000 Medical Policy Advisory Group - 10/2000 Specialty Matched Consultant Advisory Panel - 8/2002 BCBSA Medical Policy Reference Manual [Electronic Version] , 10/08/02 Specialty Matched Consultant Advisory Panel - 6/2004 Canadian Coordinating Office for Health Technology Assessment (CCOHTA). (2003, January) 24-hour ambulatory blood pressure monitoring. Retrieved November 15, 2005, from California Technology Assessment Forum. (2004, October 20) Utility of ambulatory blood pressure monitoring. Retrieved November 15, 2005, from BCBSA Medical Policy Reference Manual [Electronic Version] , 5/23/05 Appel L, Robinson K, Guallar E. Utility of Blood Pressure Monitoring Outside of the Clinic Setting. Evidence Report/Technology Assessment No. 63 (Prepared by the Johns Hopkins Evidence-based Practice Center under Contract No ). AHRQ Publication No. 03-E004. Rockville, MD: Agency for Healthcare Research and Quality. November Retrieved October 12, 2007 from downloads/pub/evidence/pdf/utbp/utbp.pdf BCBSA Medical Policy Reference Manual [Electronic Version] , 4/17/07 BCBSA Medical Policy Reference Manual [Electronic Version] , 7/10/08 Specialty Matched Consultant Advisory Panel 3/2010 Page 3 of 6
4 Specialty Matched Consultant Advisory Panel review 4/2011 BCBSA Medical Policy Reference Manual [Electronic Version] , 12/8/11 Medical Director review 3/2012 Specialty Matched Consultant Advisory Panel review 10/2012 BCBSA Medical Policy Reference Manual [Electronic Version] , 12/10/12 Specialty Matched Consultant Advisory Panel review 4/2013 O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecchia P, European Society of Hypertension Working Group on Blood Pressure Monitoring. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens Apr;23(4): Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA May 21;289(19): Retrieved from Quinn RR, Hemmelgarn BR, Padwal RS, et al., Canadian Hypertension Education Program. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol May;26(5): Retrieved from Urbina E, Alpert B, Flynn J et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 2008; 52(3): BCBSA Medical Policy Reference Manual [Electronic Version] , 1/9/14 Campbell NR1, Hemmelgarn BR. New recommendations for the use of ambulatory blood pressure monitoring in the diagnosis of hypertension. CMAJ Apr 3;184(6): National Institute of Clinical Excellence (NICE) Hypertension: Clinical Management of Primary Hypertension in Adults. August Specialty Matched Consultant Advisory Panel review 4/2014 Medical Director review 4/2014 BCBSA Medical Policy Reference Manual [Electronic Version] , 1/15/15 Specialty Matched Consultant Advisory Panel review 4/2015 Medical Director review 5/2015 Specialty Matched Consultant Advisory Panel review 4/2016 Page 4 of 6
5 Medical Director review 4/2016 Policy Implementation/Update Information 7/82 Original policy: Experimental/Investigative 11/84 Reaffirmed 4/86 Evaluated: Investigational 3/88 Evaluated: Investigational 12/95 Evaluated: Reaffirmed 1/99 Reaffirmed: Medical Policy Advisory Group 8/00 Specialty Matched Consultant Advisory Panel. Changed from investigational to not medically necessary. 9/00 System coding changes. 10/00 Medical Policy Advisory Group review. No changes to policy. Approve. 11/01 Coding Format Change. 11/01 Revised coding format change. 9/02 Specialty Matched Consultant Advisory Panel review. Duplicate codes removed from the Billing and Coding Section. Added, "There are no controlled studies to demonstrate the value of ambulatory blood pressure monitoring over home blood pressure monitoring in terms of clinical management or outcomes." to Policy Guideline section. 12/03 Benefits Application and Billing/Coding sections updated for consistency. 7/29/04 Specialty Matched Consultant Advisory Panel review 6/28/2004 with no changes made to policy criteria. References added. 3/16/06 Specialty Matched Consultant Advisory Panel review 2/27/06. No changes made to policy criteria. Rationale added to Policy Guidelines section. Policy number added to Key Words. References updated. 4/7/08 References updated. Specialty Matched Consultant Advisory Panel review 3/12/08. No change in policy statement. (adn) 4/27/10 Description section revised. Specialty Matched Consultant Advisory Panel review 3/24/10. Removed Medical Policy number. No changes in policy statement. (mco) 7/6/10 Medical Policy changed to Evidenced Based Guideline.(mco) 5/10/11 Specialty Matched Consultant Advisory Panel review 4/2011. No change in guideline statement. (mco) 3/20/12 Description section updated. When Recommended section revised to state: Automated ambulatory blood pressure monitoring over a 24-hour period is recommended for patients Page 5 of 6
6 with elevated office BP, when performed one time to differentiate between white coat hypertension and true hypertension, and when the following conditions are met: Office blood pressure elevation is in the mild to moderate range (<180/110), not requiring immediate treatment with medications; There is an absence of hypertensive end-organ damage on physical examination and laboratory testing. When not Recommended section revised to state: Other than listed above, uses of ambulatory blood pressure monitoring for patients with elevated office BP, including but not limited to repeated testing in patients with persistently elevated office BP, is not recommended. References updated. Medical Director review 3/2012. (mco) 1/29/13 Specialty Matched Consultant Advisory Panel review 10/2012. References updated. Medical Director review 1/2013. (mco) 5/14/13 Specialty Matched Consultant Advisory Panel review 4/2013. References updated. Medical Director review 3/2013. The following statement added to the Not Recommended section: Use of ambulatory blood pressure monitoring is not recommended in patients who have not tried conventional intermittent home blood pressure monitoring to evaluate for the above conditions. The When Recommended section updated as follows: Automated ambulatory blood pressure monitoring over a 24-hour period is recommended: To differentiate between white coat hypertension and true hypertension; To rule out suspected Episodic Hypertension (e.g. Pheochromocytoma); To monitor for hypertension resistant to increasing medications; To monitor for hypotensive symptoms while taking antihypertensive medications; To monitor for autonomic dysfunction; To evaluate whether antihypertensive therapy is moderating the early morning Blood pressure surge. (mco) 2/25/14 References updated. No changes to guideline statements. (mco) 5/13/14 Specialty Matched Consultant Advisory Panel review 4/2014. Medical Director review 4/2014. References updated. No changes to Guideline Statements. (mco) 7/1/15 Specialty Matched Consultant Advisory Panel review 4/2015. Medical Director review 5/2015. Evidence Based Guideline converted to Corporate Medical Policy. When Covered section updated to include, or other symptoms or findings inconsistent with in office blood pressure readings. When Covered section revised. Notification given 7/1/15 for effective date of 9/1/15. (td) 5/31/16 Specialty Matched Consultant Advisory Panel review 4/27/2016. Medical Director review 4/2016. Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the group contract and subscriber certificate that is in effect at the time services are rendered. This document is solely provided for informational purposes only and is based on research of current medical literature and review of common medical practices in the treatment and diagnosis of disease. Medical practices and knowledge are constantly changing and BCBSNC reserves the right to review and revise its medical policies periodically. Page 6 of 6
Corporate Medical Policy
Corporate Medical Policy Diagnosis and Treatment of Sacroiliac Joint Pain File Name: Origination: Last CAP Review: Next CAP Review: Last Review: diagnosis_and_treatment_of_sacroiliac_joint_pain 8/2010
More informationMEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING
MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY 02/19/09 PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product covers
More informationCorporate Medical Policy
Corporate Medical Policy Proteomics-based Testing Related to Ovarian Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: proteomics_based_testing_related_to_ovarian_cancer 7/2010
More informationCorporate Medical Policy
Corporate Medical Policy Quantitative Electroencephalography as a Diagnostic Aid for Attention File Name: Origination: Last CAP Review: Next CAP Review: Last Review: quantitative_electroencephalography_as_a_diagnostic_aid_for_adhd
More informationCorporate Medical Policy Saturation Biopsy for Diagnosis and Staging of Prostate Cancer
Corporate Medical Policy Saturation Biopsy for Diagnosis and Staging of Prostate Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: saturation_biopsy_for_diagnosis_and_staging_of_prostate_cancer
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: private_duty_nursing_services 11/3/2005 2/2016 2/2017 2/2016 Description of Procedure or Service Private
More informationKidney Transplantation and Cancer - A Review
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: renal_kidney_transplantation 4/1980 4/2016 4/2017 4/2016 Description of Procedure or Service A kidney transplant
More informationAutomated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure
Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure Policy Number: 1.01.02 Last Review: 9/2015 Origination: 1/1989 Next Review:
More informationCorporate Medical Policy
Corporate Medical Policy Continuous Monitoring of Glucose in the Interstitial Fluid File Name: Origination: Last CAP Review: Next CAP Review: Last Review: continuous_monitoring_of_glucose_in_the_interstitial_fluid
More informationCorporate Medical Policy Genetic Testing for Fanconi Anemia
Corporate Medical Policy Genetic Testing for Fanconi Anemia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_fanconi_anemia 03/2015 3/2016 3/2017 3/2016 Description
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: immune_cell_function_assay 11/2009 3/2016 3/2017 3/2016 Description of Procedure or Service Careful monitoring
More informationCorporate Reimbursement Policy
Corporate Reimbursement Policy Co-Surgeon, Assistant Surgeon, Team Surgeon and Assistant-at-Surgery Guidelines File Name: Origination: Last Review: Next Review: co-surgeon_assistant_surgeon_and_assistant_at_surgery_guidelines
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem-cell_transplantation_for_epithelial_ovarian_cancer 2/2001 11/2015 11/2016 11/2015 Description
More informationCorporate Medical Policy
Corporate Medical Policy Electrical Stimulation for the Treatment of Arthritis File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electrical_stimulation_for_the_treatment_of_arthritis
More informationCorporate Medical Policy
File Name: anesthesia_services Origination: 8/2007 Last CAP Review: 1/2016 Next CAP Review: 1/2017 Last Review: 1/2016 Corporate Medical Policy Description of Procedure or Service There are three main
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: spinal_cord_stimulation 3/1980 10/2015 10/2016 10/2015 Description of Procedure or Service Spinal cord stimulation
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: infusion_therapy_in_the_home 3/1998 2/2016 2/2017 2/2016 Description of Procedure or Service Home infusion
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: vagus_nerve_stimulation 6/1998 5/2016 5/2017 5/2016 Description of Procedure or Service Stimulation of the
More informationCorporate Medical Policy
Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Head and Neck File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_head_and_neck
More informationCorporate Medical Policy Laser Treatment of Port Wine Stains
Corporate Medical Policy Laser Treatment of Port Wine Stains File Name: Origination: Last CAP Review: Next CAP Review: Last Review: laser_treatment_of_port_wine_stains 9/2010 9/2015 9/2016 9/2015 Description
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testing_serum_vitamin_d_levels 9/2015 2/2016 2/2017 2/2016 Description of Procedure or Service Vitamin D,
More informationa Centre de Médecine Cardiovasculaire, Paris, France and b Lebanese Received 7 June 2009 Revised 6 September 2009 Accepted 17 September 2009
Devices and technology 49 Validation of three automatic devices for self-measurement of blood pressure according to the International Protocol: The Omron M3 Intellisense (HEM-71-E), the Omron M2 Compact
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: adoptive_immunotherapy 11/1993 3/2016 3/2017 3/2016 Description of Procedure or Service The spontaneous regression
More informationCorporate Medical Policy Genetic Testing for Alpha-1 Antitrypsin Deficiency
Corporate Medical Policy Genetic Testing for Alpha-1 Antitrypsin Deficiency File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_alpha_1_antitrypsin_deficiency 5/2012
More informationCorporate Medical Policy Implantation of Intrastromal Corneal Ring Segments
Corporate Medical Policy Implantation of Intrastromal Corneal Ring Segments File Name: Origination: Last CAP Review: Next CAP Review: Last Review: implantation_of_intrastromal_corneal_ring_segments 8/2008
More informationCorporate Reimbursement Policy
Corporate Reimbursement Policy Multiple Surgical Procedure Guidelines for Professional Providers File Name: Origination: Last Review: Next Review: multiple_surgical_procedure_guidelines_for_professional_providers
More informationCorporate Medical Policy Cord Blood as a Source of Stem Cells
Corporate Medical Policy Cord Blood as a Source of Stem Cells File Name: Origination: Last CAP Review: Next CAP Review: Last Review cord_blood_as_a_source_of_stem_cells 2/2001 3/2015 3/2016 3/2015 Description
More informationCorporate Medical Policy Cord Blood as a Source of Stem Cells
Corporate Medical Policy Cord Blood as a Source of Stem Cells File Name: Origination: Last CAP Review: Next CAP Review: Last Review cord_blood_as_a_source_of_stem_cells 2/2001 3/2015 3/2016 3/2015 Description
More informationCorporate Medical Policy Spinal Manipulation under Anesthesia
Corporate Medical Policy Spinal Manipulation under Anesthesia File Name: Origination: Last CAP Review: Next CAP Review: Last Review: spinal_manipulation_under_anesthesia 5/1998 1/2015 1/2016 1/2015 Description
More informationCorporate Medical Policy Allergy Immunotherapy (Desensitization)
Corporate Medical Policy Allergy Immunotherapy (Desensitization) File Name: Origination: Last CAP Review: Next CAP Review: Last Review: allergy_immunotherapy 7/1979 11/2014 11/2015 10/2015 Description
More informationCorporate Reimbursement Policy
Corporate Reimbursement Policy Guidelines for Global Maternity Reimbursement File Name: Origination: Last Review: Next Review: guidelines_for_global_maternity_reimbursement 10/2003 7/2016 7/2017 Description
More informationCorporate Medical Policy Durable Medical Equipment (DME)
Corporate Medical Policy Durable Medical Equipment (DME) File Name: Origination: Last CAP Review: Next CAP Review: Last Review: durable_medical_equipment_(dme) 1/2000 9/2015 9/2016 9/2015 Description of
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: skilled_nursing_facility_care 02/2008 2/2015 2/2016 2/2015 Description of Procedure or Service A skilled
More informationMEDICAL POLICY No. 91503-R4 BLOOD PRESSURE MONITORS & AMBULATORY BLOOD PRESSURE MONITORING
BLOOD PRESSURE MONITORS & Effective Date: December 21, 2015 Review Dates: 01/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14, 11/15 Date Of Origin: January 19, 2005 Status: Current
More informationCorporate Medical Policy
Corporate Medical Policy Computed Tomography to Detect Coronary Artery Calcification File Name: computed_tomography_to_detect_coronary_artery_calcification Origination: 3/1994 Last CAP Review 11/2014 Next
More informationCorporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate
Corporate Medical Policy Intensity-Modulated Radiation Therapy (IMRT) of the Prostate File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_the_prostate
More informationCorporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift
Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift File Name: Origination: Last CAP Review: Next CAP Review: Last Review: reconstructive_eyelid_surgery_and_brow_lift 1/2000 9/2015 9/2016
More informationCorporate Medical Policy
Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for CLL and SLL File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem-cell_transplantation_for_cll_and_sll
More informationCorporate Medical Policy Septoplasty
Corporate Medical Policy Septoplasty File Name: Origination: Last CAP Review: Next CAP Review: Last Review: septoplasty 4/1999 8/2015 8/2016 8/2015 Description of Procedure or Service There are many potential
More informationCorporate Medical Policy Continuous Passive Motion in the Home Setting
Corporate Medical Policy Continuous Passive Motion in the Home Setting File Name: Origination: Last CAP Review: Next CAP Review: Last Review: continuous_passive_motion_in_the_home_setting 9/1993 6/2016
More informationVasc Health Risk Manag. 2011; 7: 709 717. Published online 2011 November 30. doi: 10.2147/VHRM.S27193 PMCID: PMC3237100
Vasc Health Risk Manag. 2011; 7: 709 717. Published online 2011 November 30. doi: 10.2147/VHRM.S27193 PMCID: PMC3237100 Validation of four automatic devices for self-measurement of blood pressure according
More informationCorporate Medical Policy Electrical Bone Growth Stimulation
Corporate Medical Policy Electrical Bone Growth Stimulation File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electrical_bone_growth_stimulation 4/1981 6/2016 6/2017 6/2016 Description
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: microwave_tumor_ablation 12/2011 11/2015 11/2016 11/2015 Description of Procedure or Service Microwave ablation
More informationCorporate Reimbursement Policy
Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct Coding Initiative File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review:
More informationVariability of blood pressure No matter which measurement device is used, blood pressure will always be a variable haemodynamic
Guidelines 697 Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement Eoin O Brien, Roland Asmar, Lawrie Beilin, Yutaka Imai, Giuseppe Mancia,
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:
More informationCorporate Medical Policy Electromagnetic Navigation Bronchoscopy
Corporate Medical Policy Electromagnetic Navigation Bronchoscopy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: electromagnetic_navigation_bronchoscopy 1/2010 3/2016 3/2017 3/2016
More informationAntihypertensive Drug Management to Achieve Systolic Blood Pressure <120 mmhg in SPRINT
Antihypertensive Drug Management to Achieve Systolic Blood Pressure
More informationAdult & Paediatric Ambulatory Blood Pressure Monitoring Cardiac Sciences
Guideline [Optional heading here. Change font size to suit] Document Number # QH-GDL-403:2013 Adult & Paediatric Ambulatory Blood Pressure Monitoring Cardiac Sciences 1. Purpose This Guideline provides
More informationtestosterone_pellet_implantation_for_androgen_deficiency_in_men 10/2015 N/A 11/2016 10/2015 This policy is not effective until December 30, 2015
Corporate Medical Policy Testosterone Pellet Implantation for Androgen Deficiency in File Name: Origination: Last CAP Review: Next CAP Review: Last Review: testosterone_pellet_implantation_for_androgen_deficiency_in_men
More informationThe Hypertension Treatment Center
Patricia F. Kao MD MS Asst Professor, EVMS Nephrology & HTN April 26, 2014 The Hypertension Treatment Center I have no conflicts of interest to disclose Objectives Describe the role of Hypertension Treatment
More informationPrescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital
Research Article Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital *T. JANAGAN 1, R. KAVITHA 1, S. A. SRIDEVI
More informationintensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis 11/2009 5/2016 5/2017 5/2016
Corporate Medical Policy Intensity Modulated Radiation Therapy (IMRT) of Abdomen File Name: Origination: Last CAP Review: Next CAP Review: Last Review: intensity_modulated_radiation_therapy_imrt_of_abdomen_and_pelvis
More informationCorporate Medical Policy Orthotics
Corporate Medical Policy Orthotics File Name: Origination: Last CAP Review: Next CAP Review: Last Review: orthotics 6/1990 2/2016 2/2017 2/2016 Description of Procedure or Service An orthotic (orthosis)
More informationCorporate Medical Policy Urinary Tumor Markers for Bladder Cancer
Corporate Medical Policy Urinary Tumor Markers for Bladder Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: urinary_tumor_markers_for_bladder_cancer 5/2011 11/2015 11/2016
More informationOriginal Article. Results
Validity of a Wrist Digital Monitor for Blood Pressure Measurement in Comparison to a Mercury Sphygmomanometer Ana M. B. Menezes, Samuel C. Dumith, Ricardo B. Noal, Ana Paula Nunes, Fernanda I. Mendonça,
More informationCorporate Medical Policy
Corporate Medical Policy Ado-Trastuzumab Emtansine (Trastuzumab-DM1) for Treatment of File Name: Origination: Last CAP Review: Next CAP Review: Last Review: ado_trastuzumab_emtansine_(trastuzumab-dm1)_for_treatment_of_her-2_positivemalignancies
More informationThe practice of lowering blood pressure (BP)
Original Paper Treatment of Hypertension in the Inpatient Setting: Use of Intravenous Labetalol and Hydralazine Alan B. Weder, MD; 1 Steven Erickson, PharmD 2 Acute blood pressure elevations are commonly
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hyperbaric_oxygen_therapy 4/1980 1/2016 1/2017 1/2016 Description of Procedure or Service Hyperbaric oxygen
More informationBarry P McGrath, and on behalf of the National Blood Pressure Advisory Committee of the National Heart Foundation of Australia
Information from the For more information contact Heartline 1300 362 787 or www.heartfoundation.com.au Ambulatory blood pressure monitoring Position Statement Barry P McGrath, and on behalf of the National
More informationExternal Insulin Pumps Corporate Medical Policy
External Insulin Pumps Corporate Medical Policy File name: External Insulin Pumps File code: UM.DME.02 Origination: 4/2006 Last Review: 02/2014 (ICD-10 remediation only) Next Review: 10/2014 Effective
More informationAmbulatory blood pressure monitoring
STATEMENT POSITION STATEMENT Ambulatory blood pressure monitoring Barry P McGrath, and on behalf of the National Blood Pressure Advisory Committee of the National Heart Foundation of Australia THE DEVELOPMENT
More informationHealth Insurance Affects Diagnosis and Control of Hypercholesterolemia and Hypertension Among Adults Aged 20 64: United States, 2005 2008
Health Insurance Affects Diagnosis and Control of Hypercholesterolemia and Hypertension Among Adults Aged 20 64: United States, 2005 2008 Susan E. Schober, Ph.D.; Diane M. Makuc, Dr.P.H.; Cindy Zhang,
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationTherefore, a physician should only bill for new patient services when the elements of the definition is met.
Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission
More informationCorporate Medical Policy Brachytherapy Treatment of Breast Cancer
Corporate Medical Policy Brachytherapy Treatment of Breast Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: brachytherapy_treatment_of_breast_cancer 7/1996 5/2015 5/2016 5/2015
More informationCorporate Medical Policy
Corporate Medical Policy Pelvic Floor Stimulation as a Treatment of Urinary and Fecal File Name: Origination: Last CAP Review: Next CAP Review: Last Review: pelvic_floor_stimulation_as_a_treatment_of_urinary_and_fecal_incontinence
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationistent Trabecular Micro-Bypass Stent Reimbursement Guide
istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 3 4 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 10 11 Payment
More informationElevated Blood Pressure Among U.S. Adults with Diabetes, 1988 1994
Elevated Blood Pressure Among U.S. Adults with Diabetes, 1988 1994 Linda S. Geiss, MA, Deborah B. Rolka, MS, Michael M. Engelgau, MD, MS Background: Methods: Results: Conclusions: Recent guidelines and
More informationMeasurement of Blood Pressure
Measurement of Blood Pressure Ambulatory and Home Blood Pressure Monitoring BHS Non Medical Prescribing Update MSc. Management of Hypertension in Primary Care University of Birmingham February 2013 Louise
More informationPrescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007 2008
Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007 2008 Qiuping Gu, M.D., Ph.D.; Charles F. Dillon, M.D., Ph.D.; and Vicki L. Burt, Sc.M., R.N. Key findings Over the last
More informationCorporate Medical Policy Genetic Testing for Hereditary Hearing Loss
Corporate Medical Policy Genetic Testing for Hereditary Hearing Loss File Name: Origination: Last CAP Review: Next CAP Review: Last Review: genetic_testing_for_hereditary_hearing_loss 10/2013 8/2015 8/2016
More informationSubcommittee on PCCM improvement
Subcommittee on PCCM improvement Principles of Care Coordination Comprehensive services linked by an "integrator." Payments reflect patient complexity Current PCCM PCP office serves as care coordinator
More informationRefer to https://www.bcbsal.org/providers/hcreform/hcrpreventivecod ing.pdf for the Quick Reference Guide for HCR Preventive Care Services
Refer to https://www.bcbsal.org/providers/hcreform/hcrpreventivecod ing.pdf for the Quick Reference Guide for HCR Preventive Care Services Name of Policy: Preventive Care Services under Health Care Reform
More informationThe American Society of Anesthesiologists (ASA) has defined MAC as:
Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic
More informationBlue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012
Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012 Landmark Healthcare, Inc., oversees outpatient physical, occupational and speech services for BCN members
More informationStatus Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.
Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons
More informationLCD L30256 - C-Reactive Protein High Sensitivity Testing (hscrp)
LCD L30256 - C-Reactive Protein High Sensitivity Testing (hscrp) Contractor Information Contractor Name: Novitas Solutions, Inc. Contractor Number(s): 12501, 12101, 12102, 12201, 12202, 12301, 12302, 12401,
More informationHypertension and Diabetes
Hypertension and Diabetes C.W. Spellman, D.O., Ph.D., FACOI Professor & Associate Dean Research Dir. Center Diabetes & Metabolic Disorders Texas Tech University Health Science Center Midland-Odessa, Texas
More informationCorporate Medical Policy Breast Surgeries
Corporate Medical Policy Breast Surgeries File Name: Origination: Last CAP Review: Next CAP Review: Last Review: breast_surgeries 1/2000 9/2015 9/2016 9/2015 Description of Procedure or Service Policy
More informationTreatment of Hypertension: JNC 8 and More
PL Detail-Document #300201 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER February 2014 Treatment of
More informationCardiopulmonary Exercise Stress Test (CPET) Archived Medical Policy
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationHow can nutrition education contribute to competency-based resident evaluation? 1 4
How can nutrition education contribute to competency-based resident evaluation? 1 4 Darwin Deen ABSTRACT The Curriculum Committee of the Nutrition Academic Award (NAA) has created a consensus document
More informationHEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE
HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: DIAGNOSIS OF SLEEP APNEA IN ADULTS DATE: 5/9/2013 HERC COVERAGE GUIDANCE The following diagnostic tests for Obstructive Sleep Apnea (OSA) should
More informationNUVIGIL (armodafinil) oral tablet
NUVIGIL (armodafinil) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage
More informationName of Policy: Reconstructive versus Cosmetic Surgery
Name of Policy: Reconstructive versus Cosmetic Surgery Policy #: 106 Latest Review Date: February 2010 Category: Administrative Policy Grade: Background/Definitions: As a general rule, benefits are payable
More informationThe FDA s Mini- Sen*nel Program and the Learning Health System
info@mini- sen*nel.org 1 The FDA s Mini- Sen*nel Program and the Learning Health System Richard PlaB, MD, MS Harvard Pilgrim Health Care Ins*tute Harvard Medical School October 1, 2014 Vision We seek the
More informationProfessional Certificate in Primary Care Psychology
Professional Certificate in Primary Care Psychology The NAPPP Primary Care Psychology Certificate training program requires the completion of 10 courses. Each course awards 15 CE credit hours. NAPPP is
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More informationAHA/ASH/PCNA Scientific Statement
AHA/ASH/PCNA Scientific Statement Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary A Joint Scientific Statement From the American Heart Association, American
More information9/19/2013. Standardizing Preventive Care for Hypertension. About the Speaker. About the Speaker
Standardizing Preventive Care for Hypertension Olga Felton RN, MSN, NCM John Kern MD, CMO Regional Mental Health Center Northwest Indiana About the Speaker John Kern, MD is Chief Medical Officer at Regional
More informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationCDS Starter Kit: Diabetes f ollow-up care
CDS Starter Kit: Diabetes f ollow-up care Introduction The delivery of high-quality diabetes care is a complex process that requires a provider to consider many pieces of patient information and treatment
More informationCorporate Medical Policy
Corporate Medical Policy Polysomnography for Non Respiratory Sleep Disorders File Name: Origination: Last CAP Review: Next CAP Review: Last Review: polysomnography_for_non_respiratory_sleep_disorders 10/2015
More informationCardiovascular Risk in Diabetes
Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,
More informationMedical Statistics, School of Medicine, University of Athens, Greece
Original Research Hellenic J Cardiol 2012; 53: 432-438 Circadian Variation of Blood Pressure and Heart Rate in Normotensives, White-Coat, Masked, Treated and Untreated Hypertensives Eleni Koroboki 1, Efstathios
More informationFrom Concept to Rapid Visualization a Data Analytics Case Study
From Concept to Rapid Visualization a Data Analytics Case Study Gregory Wozniak, PhD Director of Outcomes Analytics Health Outcomes Group American Medical Association The Journey Objectives Share experiences
More informationManaging Asthma Long Term
Managing Asthma Long Term TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS F I G U R E 4 2 a. CLASSIFYING ASTHMA SEVERITY AND INITIATING TREATME N T IN CHILDREN 0 4
More informationPopulation Health Management Program
Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care
More information