Provider Alert! CPT Coding for Self-Measured Blood Pressure Monitoring

Date: February 18, 2021
Attention: All providers

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan would like to inform network providers of Current Procedural Terminology (CPT®) Codes available to support self-measured blood pressure monitoring.

How this impacts providers: The CPT Codes include the following:

• 99473 can be submitted once when physician practice staff provide training, device setup and calibration, and patient instruction on proper technique. Limited to one service per year. May be considered for more than once per year when documentation of medical necessity is submitted with the claim.
• 99474 can be submitted monthly when patients and/or their caregivers report their blood pressure readings back to the practice- whether it is done electronically or in person with a written log. Limited to four services per year and payable if procedure code 99473 has been submitted within the past 12 rolling months.
• A4670 can be submitted for an automated blood pressure monitor. These are a covered benefit under Texas Medicaid for the purpose of self-monitoring in the home setting. Limited to one monitor per year.

Procedure code A4670 does not require prior authorization when billed with a diagnosis code listed in Section 2.2.7.1 of the Texas Medicaid Provider Procedure Manual.

Documentation requirements and other useful tops can be found in The 7-step Self-Measured Blood Pressure (SMBP) Quick Guide, produced by the AMA.

Next steps for providers: Providers should share this information with their staff.

Resource: https://dshs.texas.gov/heart/

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.