Medicare Coverage of Blood Pressure Monitors
This article explains Medicare coverage of blood pressure monitors. This includes both standard blood pressure monitors (“cuffs”) or ambulatory blood pressure monitoring (ABPM) devices, for use at home by a patient.
Are Blood Pressure Monitors Covered by Medicare?
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.
Medicare Part C 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. Be aware that the supplier from which you rent your device can have an impact on how much you pay, for reasons described below.
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).
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 another authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care or equipment is necessary and proper.
- The care or equipment must be provided by a healthcare provider or equipment supplier who participates in Medicare.
Learn more about Medicare coverage of devices and services in our full Guide to Medicare.