Self-Measured Blood Pressure (SMBP) Monitoring
The MO HealthNet Division (MHD) implemented coverage for SMBP monitoring effective for dates of service on or after February 1, 2025. These services are covered when prescribed by a physician or a health care professional with prescribing authority. Prescriptions for SMBP-validated monitoring devices must be made to participating Durable Medical Equipment (DME) providers and must include a request for an appropriately sized cuff.
SMBP monitoring device limitations include:
- Eligible participants may receive one (1) device every three (3) years.
- Participants should use devices with upper-arm cuffs of appropriate size; a wrist cuff should be used only if an upper-arm cuff is not clinically appropriate or if an appropriately sized upper-arm cuff is unavailable.
SMBP Monitoring Clinical Support Current Procedural Terminology (CPT) Code limitations:
- CPT Code 99473: May be submitted once per year when training the participant, device setup and calibration, instruction on proper technique or for assessing clinical accuracy of the device.
- CPT Code 99474: May be submitted, at a maximum, once per calendar month when participants or their caregivers report their blood pressure readings back to their provider, whether it is done electronically or in person, with a written log and a treatment plan has been created or modified based on documented averages of the blood pressure readings.
Participant Eligibility
Participants who are pregnant or within 12 months postpartum and have at least one of the following established risk factors:
- Diagnosis of hypertension
- History of at least one of the following: preeclampsia, eclampsia, hypertension, or gestational hypertension
- Family history of at least one of the following: preeclampsia, eclampsia, hypertension, or gestational hypertension
- Obesity with a Body Mass Index (BMI) of 30 or greater
- Advanced maternal age is defined as 35 years of age or older
- Autoimmune disorder(s)
- Elevated blood pressure during previous visit or screening
- Population-level risk factors such as race or geographical location
Other MO HealthNet participants who are not pregnant or within twelve (12) months postpartum must meet at least one of the following criteria:
- Newly diagnosed hypertension within the last six (6) months
- Uncontrolled hypertension or multiple co-morbidities such as, but not limited to, diabetes, obesity, or hypercholesterolemia
- History of a condition that affects blood pressure, such as, but not limited to, heart disease, heart failure, stroke, congenital heart disease, or renal disease
The table below lists the covered procedure codes, descriptions of the codes, and the reimbursement rates:
Procedure Code | Description | Reimbursement Rate |
| 99473 | Education and training to self-measure blood pressure | $11.14 |
| 99473 TH | Education and training to self-measure blood pressure for pregnant women and 12 months postpartum | $11.14 |
| 99474 | Self-measured blood pressure measurements | $13.18 |
| 99474 TH | Self-measured blood pressure measurements for pregnant women and 12 months postpartum | $13.18 |
| A4670 | Automatic blood pressure monitor ages 21 & over | $60.48 |
| A4670 EP | Automatic blood pressure monitor ages 20 & under | $60.48 |
For more coverage details regarding SMBP monitoring, refer to the Physician Provider Manual.
For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. Email MHD.Education@dss.mo.gov for more information.