Because high blood pressure often has no symptoms, your patients may not be aware of their blood pressure numbers or risk for hypertension until a routine preventive care visit.

According to the American Heart Association, nearly half of U.S. adults have high blood pressure.* Less than half of adults (42%) with hypertension are diagnosed and treated, and approximately 1 in 5 adults (21%) have their hypertension under control, according to the World Health Organization.**

Cigna Healthcare^sm medical records reviews have found in the past that blood pressure readings are sometimes not captured in collected medical records, particularly those for virtual care visits. In 2022, the National Committee for Quality Assurance updated the Healthcare Effectiveness Data and Information Set (HEDIS®)*** guidelines to allow for patient self-reported blood pressure values — which can help to close this reporting gap and drive better health outcomes.

Claims for patients with hypertension

For quality tracking purposes, and in accordance with HEDIS guidelines, providers can submit claims with Current Procedural Terminology Category II (CPT® II) codes for patients ages 18–85 with a diagnosis of hypertension.

Coverage policy and coding for self-measured blood pressure

Our coverage policies have recently been updated to support enhanced preventive care for patients with hypertension through home blood pressure monitoring. Providers can now submit claims for self-measured blood pressure (SMBP) patient education, device calibration, and monitoring.

SMBP monitoring is considered medically necessary for hypertension when the following criteria are present:

• The device is prescribed and administered by a board-eligible or board-certified medical provider or subspecialist (e.g., cardiologist, pulmonologist, endocrinologist), nurse practitioner, or physician assistant.
• Physiologic data are electronically collected and automatically uploaded for analysis and interpretation.
• The home blood pressure cuff is intended for the purpose of displaying or analyzing the physiological parameters measured by the device.
• The home blood pressure cuff is used for remote communication, counseling, and monitoring of acute or chronic health conditions.

Claims for SMBP monitoring

Your patients may ask about managing blood pressure

Your patients ages 18–64 with a diagnosis of hypertension who have not had a wellness visit in the past 12 months recently received emails and/or postcards from Cigna Healthcare reminding them of the importance of medication compliance, scheduling preventive screenings, and making heart-healthy lifestyle changes.

Resources

• Providers can learn more about best practices for controlling hypertension, accurate coding and documentation, and common billing codes on the Controlling High Blood Pressure resource page on the Cigna for Health Care Professionals website (CignaforHCP.com).
• Providers can access the updated Preventive Care Services coverage policy at CignaforHCP.com.
• Patient education is available on the Wellness Library page at Cigna.com.
• Providers and patients can access blood pressure education, provider webinars, and more on the Target: BP website. Target: BP, a national initiative created by the American Heart Association and the American Medical Association, focuses on blood pressure improvement, SMBP, patient education, and data collection.

* American Heart Association. “Facts About High Blood Pressure.” American Heart Association. 2024. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure.

** World Health Organization. “Hypertension.” World Health Organization. 2023. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Key%20facts&text=An%20estimated%2046%25%20of%20adults,hypertension%20have%20it%20under%20control.

*** HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).