Medicare Coverage of Blood Pressure Monitor

What It Is

A blood pressure monitor ("cuff") or an ambulatory blood pressure monitoring (ABPM) device, for use at home by a patient

What's Covered

Blood pressure monitors for use at home aren't covered by Medicare, with two exceptions:

• A blood pressure monitor and stethoscope for a patient receiving blood dialysis (hemodialysis or peritoneal dialysis) in the home

• An ambulatory blood pressure monitoring (ABPM) device, which takes and stores blood pressure readings in 24-hour cycles, for a patient who, a physician believes, has "white coat hypertension" (artificially high blood pressure readings when taken in a doctor's office) based on repeated in-office and out-of-office testing

If covered, Medicare Part B pays for the rental of the blood pressure monitoring device. The monitor must be rented from a Medicare-certified medical equipment supplier.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for a blood pressure monitor, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount for rental of a covered blood pressure monitoring device; the patient is responsible for the remaining 20 percent.

Warning: If a blood pressure monitor is rented from what's called a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount. However, a supplier who's enrolled in Medicare but isn't an officially participating supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare doesn't pay).

Important: Regardless of the rules regarding any particular type of care or equipment, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care or equipment must meet two basic requirements:

• The care or equipment must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care or equipment is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

• The care or equipment must be provided by a healthcare provider or equipment supplier who participates in Medicare.