EmblemHealth covers automatic blood pressure monitors for all lines of business—with no member cost-share or preauthorization requirement—for its members diagnosed with hypertension, provided they meet these coverage criteria:
- Member is age 11 or over.
- The cost of the device does not exceed $40.
- The member obtains the device through a contracted vendor.
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, management of your patients, and improve your performance rate for the Quality measure: Controlling Blood Pressure.
Learn more about the recommended steps and the codes required for Quality care gap closure. The CDC offers educational materials for you to hand out to members to support Self-Measured Blood Pressure Monitoring | Million Hearts®.
*This is an EmblemHealth benefit only for members diagnosed with hypertension. There is a limit of one unit every five years.
JP 63744 11/2023