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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that home blood pressure monitors (A4660) and home blood pressure cuffs (A4663) are 
considered home dialysis supplies. These items are only covered for patients on home dialysis and they are not 
payable to Durable Medical Equipment suppliers. You can find this rule in the Centers for Medicare and 
Medicaid Services, Internet Only Manual, Publication 100-02, Medicare Benefit Policy Manual, Transmittal 
250, Change Request 11021, Attachment B, dated November 14, 2018. 
 
The rules also say that ambulatory blood pressure monitoring (ABPM) is a diagnostic test that allows for the 
identification of various types of high blood pressure (BP). ABPM devices are small portable machines that are 
connected to a blood pressure cuff worn by patients that record blood pressure at regular periods over 24 to 48 
hours while the patient goes about their normal activities, including sleep. The recording is interpreted by a 
physician or non-physician practitioner, and appropriate action is taken based on the findings. Diagnosis and 
treatment of high BP is important for the management of various conditions including cardiovascular disease 
and kidney disease. For dates of service on and after July 2, 2019, the Centers for Medicare & Medicaid 
Services (CMS) believes that the evidence is sufficient to determine that ABPM is reasonable and necessary for 
the diagnosis of hypertension in Medicare beneficiaries under the following circumstances: 
1. For beneficiaries with suspected white coat hypertension, which is defined as average office BP of 
systolic BP > 130 mm Hg but < 160 mm Hg, or diastolic BP > 80 mm Hg but < 100 mm Hg on two 
separate clinic/office visits with at least two separate measurements made at each visit, and with at least 
two BP measurements taken outside the office which are < 130/80 mm Hg. 
2. For beneficiaries with suspected masked hypertension, which is defined as average office BP between 
120 mm Hg and 129 mm Hg for systolic BP, or between 75 mm HG and 79 mm Hg for diastolic BP on 
two separate clinic/office visits with at least two separate measurements made at each visit, and at least 
two BP measurements taken outside the office which are  130/80 mm Hg. 
ABPM devices must be:  
 capable of producing standardized plots of BP measurements for 24 hours with daytime and night-time 
windows and normal BP bands demarcated; and,  provided to patients with oral and written instructions and a test run in the physicians office must be 
performed; and, 
 interpreted by the treating physician or treating non-physician practitioner. 
For eligible patients, ABPM is covered once per year. 
You can find this information at National Coverage Determination (NCD) for Ambulatory Blood Pressure 
Monitoring (20.19). 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.