• 24-hour Blood Pressure Monitoring

10 Features to Consider before Holter Purchase. FREE GUIDE after subscription!

Your name (required)

Your e-mail (required)

Your country

ABPM Reimbursement Rates and Coding Guidelines in the USA

Your ABPM Pays for Itself!

Add Value to Your Practice with Meditech ABPM Monitors!

ABPM Reimbursement Rates and Coding Guidelines in the USA

ABPM reimbursement is critical when deciding how to incorporate ambulatory BP monitoring into your practice. While Medicare will reimburse an ABPM test only in case of suspected white coat hypertension, private insurance providers may reimburse for additional indications as well.

ABPM Reimbursement at Medicare: $60 - $120

ABPM is covered for those beneficiaries with suspected white coat hypertension only, which is defined as:

a) clinic/office blood pressure > 140/90 mmHg on at list 3 separate clinic/office visits with 2 separate measurements made at each visit

b) at at least 2 documented separate blood pressure measurements taken outside the clinic/office which are < 140/90 mmHg

c) no evidence of end-organ damage

ICD-9 Diagnosis Code

796.2 – Elevated blood pressure reading without diagnosis of hypertension.

ABPM Reimbursement at Private Insurance Providers: $55 - $300

Private insurance providers reimburse for a broad range of conditions, and their reimbursement rates are higher than Medicare rates.

ICD-9 Diagnosis Codes

401 – essential hypertension ABPM reimbursement401.1 – benign hypertension
401.9 – unspecified hypertension (resistant)
402 – hypertensive heart disease
402.1 – benign hypertensive heart disease
402.9 – unspecified hypertensive heart disease
402.90 – unspecified hypertension without congestive heart failure
403 – hypertensive renal disease
413 – nocturnal angina
429 – ill-defined descriptions and complications of heart disease
458 – orthostatic hypotension
458.9 – unspecified hypotension
642 – Hypertension complicating pregnancy, childbirth, and puerperium
642.3 – Transient hypertension of pregnancy
642.4 – mild or unspecified preeclampsia
642.9 – unspecified hypertension complicating pregnancy
669.2 – maternal hypotension syndrome
780.2 – syncope and collapse
796.2 – elevated blood pressure reading without diagnosis of hypertension
997.91 – other hypertension - episodic

CPT (Current Procedural Terminology) Codes

CPT coding is maintained by the American Medical Association to define the treatment and services provided for diagnosis.

93784 – ABPM utilizing a system for 24 hours or longer, including recording, scanning analysis, interpretation, and report.
93786 – Recording only.
93788 – Scanning analysis with a report.
93790 – Physician review with interpretation and report.

ICD-10 Diagnosis Codes

ICD-10 will replace ICD-9 on Thursday, October 1, 2015.

On April 1, 2014, President Obama signed the Protecting Access to Medicare Act, which addresses a variety of health policy issues. One of those issues is a delay in the transition from ICD-9 to ICD-10 code sets. The law states: The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.

For the new ICD-10 codes please visit: icd10data.com.