MedicaidCoverageHigh impact
OHP coverage of home blood pressure monitoring services during the COVID-19 emergency
Oregon Health Plan·OR · Cardiology, Internal Medicine, Family Medicine +1 more·Plan
Effective date
Sep 3, 2020
We identified it
Aug 19, 2026
Summary
OHP now covers home blood pressure monitoring supplies (standard and automatic cuffs) and related telemedicine visit codes (99473, 99474) without prior authorization during the COVID-19 emergency for patients with above-the-line diagnoses on the Prioritized List. Providers must document medical necessity and ensure proper patient education and monitoring protocols.
Action Required
Immediately: (1) Billing team must update system to recognize CPT codes 99473 and 99474 as covered services without prior authorization for OHP members. (2) Ensure DME billing processes accept HCPCS codes A4760 and A4670 without prior auth when accompanied by provider prescription and visit note documenting medical necessity. (3) Update fee-for-service claims routing to OHP-enrolled DME suppliers. (4) For CCO members, coordinate with contracted DME providers to ensure supply availability. (5) Providers must document medical necessity in visit notes (telemedicine or in-person) and establish protocols for patient education, cuff fitting, and in-person referral criteria. (6) Clinical staff should designate responsibility for patient check-ins on blood pressure monitoring and establish escalation protocols. Failure to properly document medical necessity or route claims through enrolled DME suppliers will result in claim denials.