Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · CA · Cardiology, Internal Medicine, Family Medicine +1 moreMedium impact
Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure (1.01.02)
Effective date
Nov 1, 2026
Identified
Oct 31, 2026
Summary
Blue Shield of California's medical policy 1.01.02 on automated 24-hour ambulatory blood pressure monitoring for diagnosing hypertension has an effective date of November 1, 2026. The policy statement covers this monitoring when it is performed 1 time to differentiate white coat hypertension from true hypertension and when one of two sets of criteria is met. For individuals aged 13 and older, office blood pressure should be SBP greater than or equal to 130 or DBP greater than or equal to 80 mmHg and less than 160/100 mmHg; for individuals younger than 13, office BP should be the lower of at or above the 95th percentile based on gender, age and height per the AAP 2017 pediatric tables, or at or above the adult cutoff; and in both cases the clinical presentation should not require immediate initiation of antihypertensive medication based on the severity of BP elevation or acute hypertensive end-organ injury.
Get alerts when payers change rules like this one
We check Blue Shield of California and other payers every day and email you when a change matches your specialty and state.
01Already effective November 1, 2026: The billing team should check the current applicability of this policy with the Prior Authorization Department at (800) 541-6652, which the source gives for questions about applicability.
02For ABPM requests and claims, collect the documentation the source asks for: a history and physical and/or consultation report including documentation reflecting the blood pressure elevation, documentation of absence of end-organ damage, laboratory testing results, and the reason for 24-hour automated ambulatory blood pressure monitoring.
03After the service, the source also asks for the results or reports of the tests performed.
04Refer to the member's contract benefits in effect at the time of service to determine coverage.
Codes mentioned
937849378693788937909947399474A4670
Original notice
Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure (1.01.02)
blueshieldca.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.