Hypertension and Remote Patient Monitoring (RPM) 

Medi-Cal Rx

Personal home use blood pressure monitors and blood pressure cuffs for use with personal home blood pressure monitoring devices are a covered benefit under Medi-Cal Rx, as a pharmacy-billed item. If your Medi-Cal patients need a blood pressure monitor, follow these steps:

1. Write a prescription stating the medical reason/need for blood pressure monitoring or ICD 10 code. Include NDC. Click here for a list of covered blood pressure monitoring devices and blood pressure cuffs.
2. Send the prescription to your patient’s local pharmacy.

Other HPSM plans

Blood pressure monitors may be part of the pharmacy benefit for other HPSM plans. For more information click here.

HPSM covers blood pressure monitors for eligible members as part of the DME benefit. The DME benefit guidelines are included below:

• For Medi-Cal, HealthWorx, ACE: A cuff blood pressure monitor is covered once every five years.
• For CareAdvantage: An ambulatory blood pressure monitor is covered once a year OR for CareAdvantage members undergoing dialysis at home, a cuff blood pressure monitor is covered once a year.

If your patient needs a blood pressure monitor, complete the DME vendor’s order form. See a list of DME vendors.

• Discuss with your patients why self-measured blood pressure is important to their care. Share that self-measured blood pressure:
  • helps with diagnosis.
  • can lead to better blood pressure control, which reduces the risk of heart attack and stroke. Patients who understand the importance of self-measured blood pressure are more likely to remain engaged.
• Teach your patients how to accurately check their blood pressure. To ensure your patients accurately check their blood pressure, provide guidance on the following:
  • Choosing the correct cuff size.
  • Positioning the cuff correctly on the arm.
  • What steps to take to prepare for measuring blood pressure, including correct posture.
  • How to turn on the device and measure blood pressure.
  • What the blood pressure reading means.
  • How to document blood pressure readings.
  • How often to measure.
• Ask your patients to teach back what they have learned to ensure they understood how to correctly measure their blood pressure.
• Provide guidance on what your patients should do if they get high blood pressure readings.
• Inform your patients that a single high reading (SBP between 140-180 or DBP between 90-120 mm Hg) is not an immediate cause for alarm. If your patients get a reading that is slightly or moderately higher than normal, ask that they take their blood pressure a few more times and follow up with you to verify if there’s a health concern or any issues with their monitor.
• Instruct your patients on what to do if blood pressure readings suddenly exceed SBP 180 and/or DBP120 mm Hg. Let patients know to wait five minutes and check their blood pressure again. If the readings are still unusually high and they are not experiencing any other symptoms of target organ damage, such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking, instruct patients to contact you immediately. Members can also call HPSM’s Nurse Advice Line at 1-833-846-8773 to speak to a Licensed Registered Nurse (RN) if they think they need urgent medical attention, but are not sure.
• Instruct your patients to call 911 immediately if their blood pressure is higher than SBP 180 and/or DBP120 mm Hg and they are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking.
• Remind your patients to schedule a follow-up visit with you to review their blood pressure readings. This is especially important if results are not in the goal range. Consider more frequent follow up until blood pressure is at goal.
• Share educational resources with your patients.
  • American Medical Association’s seven simple tips to get an accurate blood pressure reading with your patients. The tips are available in English and Spanish.
  • American Heart Association’s video for monitoring blood pressure at home, available here.

Identifying patients who have hypertension is a key step in helping them manage this health condition. By appropriately diagnosing hypertension and reporting blood pressure measurements, we can work together to improve health outcomes. Use the tips below when documenting blood pressure measurements taken by patients using a digital device.

• Document when your patients take their blood pressure with a digital device at home. Blood pressure measurements taken by a patient and documented in the patient’s medical record are eligible for use in reporting if the patient uses a digital monitoring device. Make sure the documentation in the medical record states that the reading was taken with a digital device and interpreted by you.
• If there are multiple blood pressure measurements on the same date of service, you can either:
  • Record an average blood pressure based on the patient’s reported blood pressure readings. Make sure to record the average blood pressure reading with the date of encounter/visit when the average was captured.
  • Or you can use the lowest systolic and lowest diastolic blood pressure as the representative blood pressure reading for coding. The systolic and diastolic results do not need to be from the same reading.
• Record one date for patient reported blood pressure measurement in Electronic Medical Record (EMR). If the blood pressure measurement is from the day of the encounter/visit, you can record the date of the encounter/visit. If the blood pressure measurement is not from the day of the encounter/visit, you can still record the date of the encounter/visit as the date the blood pressure measurement was captured.
• Follow HPSM’s Benchmark Pay for Performance (P4P) Program Guidelines. Primary care clinics receive monitoring reports of blood pressure control (<140/90 mm Hg) for assigned patients with hypertension through HPSM eReports. Clinics serving adult Medi-Cal and/or CareAdvantage patients are eligible for incentive payments under HPSM’s Benchmark Pay-for-Performance program if blood pressure is controlled for patients meeting all of the following criteria:
  • 18-85 years old;
  • At least two outpatient visits for primary or specialty care in the calendar year;
  • A diagnosis of hypertension in the first six months of the calendar year AND the year prior.