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KMAP BULLETIN: Management of Self-monitoring Blood Pressure (SMBP) Treatment Plans

Date: 12/21/23

KMAP GENERAL BULLETIN 23315 (PDF)

Effective with dates of service on and after January 1, 2024, professional services to validate blood pressure equipment, training and interpretation of blood pressure readings, will be covered using the following codes:

99473 - Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration.

  • This code is allowed annually and reimbursed at $7.50*

99474 - Separate self-measurements of two reading one minute apart, twice daily over a 30-day period (a minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communications of a treatment plan to the patient.

  • This code is allowed up to four times per year and reimbursed at $9.27*. This limitation may be exceeded with prior authorization.

An acceptable diagnosis code from the following ranges must be included on the claim:

  • I12.0-I12.9 - Hypertensive chronic kidney disease
  • I13.0-I13.2 - Hypertensive heart and chronic kidney disease
  • I50.1-I50.9 - Heart failure
  • N18.5-N18.6 - Chronic-kidney disease, stage 5, and endstage renal disease (ESRD)

Covered Provider Type/Provider Specialty (PT/PS) are 31/000, 31/349, 09/093, and 10/100.

Note: Finger and wrist monitors are not covered for heart failure and ESRD diagnoses.

*The rates noted in this bulletin are subject to future changes. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.

Note: The effective date of the policy is January 1, 2024. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the KMAP bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Professional Fee-forService Provider Manual, Section 8410, page 8-36.