Obstetrical Hypertension Programs

Number: 0368

Policy

Aetna considers obstetrical hypertension programs experimental and investigational because they have not been proven to be more effective than member self-management performed in concert with supervision by an obstetrician in reducing fetal or maternal morbidity and mortality.

Background

Obstetrical hypertension programs offer a “package” approach to the outpatient care of the hypertensive pregnant patient.  These programs typically use a device to measure blood pressure and pulse, and to transmit measurements of daily weight, fetal movement count, and urine proteinuria.  The programs do not assure patient compliance with physician instructions regarding the ambulatory management hypertension.

For mild preeclampsia, conservative management is recommended by the American College of Obstetricians and Gynecologists (ACOG) for any woman not undergoing delivery.  Conservative management involves monitoring the patient's blood pressure, proteinuria, renal and hepatic function, platelet counts, and serial sonography for fetal growth.  The frequency with which these parameters are monitored should depend on gestational age and circumstance of the patient and fetus. Inpatient or outpatient management may be appropriate.

Table: CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

HCPCS codes not covered for indications listed in the CPB:

S9211 Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9212 Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9213 Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)

ICD-10 codes not covered for indications listed in the CPB:

O10.011 - O10.019
O10.911 - O10.919
Hypertensive heart disease and hypertension complicating pregnancy, childbirth, and the puerperium
O10.111 - O10.119, O10.211 - O10.219, O10.311 - O10.319, O11.1 - O11.9 Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium
O10.411 - O10.419 Hypertension secondary, complicating pregnancy, childbirth, and the puerperium
O11.1 - O11.9 Pre-existing hypertensive disorder with superimposed proteinuria
O13.1 - O13.9 Gestational (pregnancy induced) hypertension without significant proteinuria
O14.00 - O14.03
O14.90 - O14.95
Gestational (pregnancy induced) hypertension with significant proteinuria
O14.10 - O14.13 Severe pre-eclampsia
O15.00 - O15.9 Eclampsia in pregnancy
O16.1 - O16.9 Unspecified maternal hypertension

The above policy is based on the following references:

  1. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;(1):CD002252.
  2. Alavifard S, Chase R, Janoudi G, et al. First-line antihypertensive treatment for severe hypertension in pregnancy: A systematic review and network meta-analysis. Pregnancy Hypertens. 2019;18:179-187.
  3. American College of Obstetrics and Gynecology (ACOG). Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 29. Washington, DC: ACOG; July 2001.
  4. Bergel E, Carroli G, Althabe F. Ambulatory versus conventional methods of blood pressure monitoring during pregnancy. Cochrane Database Syst Rev. 2002;(2):CD001231.
  5. Crowther CA, Bouwmeester AM, Ashurst HM. Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension . Br J Obstet Gynaecol. 1992;99(1):13-17.
  6. Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: A systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367-1375.
  7. Ferrer RL, Sibai BM, Mulrow CD, et al. Management of mild chronic hypertension during pregnancy: A review. Obstet Gynecol. 2000;96(5 Pt 2):849-860.
  8. Hirshberg A, Downes K, Srinivas S, et al. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: A randomised clinical trial. BMJ Qual Saf. 2018;27(11):871-877.
  9. Honigberg MC, Zekavat SM, Aragam K, et al. Long-term cardiovascular risk in women with hypertension during pregnancy. J Am Coll Cardiol. 2019;74(22):2743-2754.
  10. Mathews DD. A randomized controlled trial of bed rest and sedation or normal activity and non-sedation in the management of non-albuminuric hypertension in late pregnancy. Br J Obstet Gynaecol. 1977;84(2):108-114.
  11. Maxwell CV, Amankwah KS. Alternative approaches to preterm labor. Semin Perinatol. 2001;25(5):310-315. 
  12. Mulrow CD, Chiquette E, Ferrer RL, et al. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment 14. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2000.
  13. No authors listed. National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 1990;163(5 Pt 1):1691-1712.
  14. Roberts JM. Pregnancy-related hypertension. In: Maternal Fetal Medicine. 3rd ed. RK Creasy, R Resnik, eds, Philadelphia, PA: WB Saunders Co.; 1994:804-843.
  15. Scott JR. Hypertensive disorders of pregnancy. In: Danforth's Obstetrics and Gynecology. 7th ed. JR Scott, PJ Disaia, CB Hammond, WN Spellacy, eds, Philadelphia, PA: JB Lippincott Company; 1994:351-365.
  16. Shireen M, Edgardo A, Guillermo C. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev. 2005;(4):CD003514.
  17. Sibai BM, Barton JR, Akl S, et al. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol. 1992;167(4 Pt 1):879-884.