MedicaidCoverageMedium impact
Self-Measured Blood Pressure (SMBP) Monitoring
Missouri Medicaid (MO HealthNet)·MO · Family Medicine, Internal Medicine, OB-GYN +2 more·Provider Notice
Effective date
Feb 1, 2025
We identified it
Jun 20, 2026
Summary
MO HealthNet Division implemented new coverage for Self-Measured Blood Pressure (SMBP) monitoring services effective February 1, 2025. The policy covers specific CPT codes for patient education/training and blood pressure monitoring with defined frequency limitations and eligibility criteria for pregnant/postpartum women and other participants with hypertension-related conditions.
Action Required
Immediately: Billing team must update system to recognize new SMBP monitoring codes 99473 (training - once per year, $11.14), 99474 (monitoring - once per month maximum, $13.18), and A4670 (BP monitor device, $60.48). Add TH modifiers for pregnant/postpartum patients. Update encounter forms to include eligibility verification for hypertension diagnosis, pregnancy status, or qualifying risk factors. Ensure providers document appropriate clinical criteria before billing these services.