Key facts for NCD 20.19
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 07/02/2019
- Implemented 06/16/2020
- Transmittal
- Transmittal 10073
- Versions published
- 3
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.19 sets Medicare's national policy for ambulatory blood pressure monitoring under the benefit category "Diagnostic Tests (other)", effective 07/02/2019 and implemented 06/16/2020. 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… It has been revised 2 times since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
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.
Indications and limitations of coverage
B. Nationally Covered Indications
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:
• For beneficiaries with suspected white coat hypertension, which is defined as average office BP of systolic BP > 130 mm Hg but 80 mm Hg but
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 physician’s office must be performed; and,
• interpreted by the treating physician or treating non-physician practitioner.
For eligible patients, ABPM is covered once per year.
C. Nationally Non-Covered Indications
N/A
D. Other
Coverage of other indications for ABPM not indicated above are at the discretion of the Medicare Administrative Contractors.
(Last reviewed July 2019.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.19 version 3. View the original on cms.gov.
Revision history
05/2020 - The purpose of this change request is to inform contractors that for dates of service on and after July 2, 2019, CMS will cover Ambulatory Blood Pressure Monitoring for the diagnosis of hypertension in Medicare beneficiaries under updated criteria. ( TN 10073 ) (CR11650)
11/2016 - This change request (CR) is the 9th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, and CR9631. Some are the result of revisions required to other NCD-related CRs released separately.
Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. ( TN 1753 ) (CR9751)
08/2016 - This change request (CR) is the 9th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, CR9540, and CR9631. Some are the result of revisions required to other NCD-related CRs released separately.
Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. ( TN 1708 ) (CR9751)
09/2012 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.Implementation date: 01/07/2013 Effective date: 10/1/2015. ( TN 1122 ) ( TN 1122 ) (CR 7818)
03/2003 - Specified physician is required to perform interpretation of data obtained through ABPM, but no requirements regarding setting where interpretation performed. Effective and implementation dates 07/01/2003. ( TN 168 ) (CR 2625)
12/2001 - Changed status from non-covered to covered and clarified conditions under which ABPM is covered. Effective and implementation dates 04/01/2002. ( TN 149 ) (CR 1985)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 20.19
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 20.19
What does NCD 20.19 cover?
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: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.19 take effect?
The current version (3) is effective 07/02/2019, implemented 06/16/2020, published in transmittal 10073. CMS lists 3 versions of this NCD.
Does a Local Coverage Determination override NCD 20.19?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.