Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries

• Only 68% of Medicare claims for ambulatory blood pressure are reimbursed.
• Claims are likely to be reimbursed if the ICD-9 diagnosis code 796.2 is included.
• Less than 30% of claims without a 796.2 diagnosis code were reimbursed.
• The median reimbursement amount for an ABPM procedure was $52.01.

Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007 and 2010 that were reimbursed. Among 1970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 (“elevated blood pressure reading without diagnosis of hypertension”) versus 28.5% of claims without this code. Among claims without an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 listed, those for the component (eg, recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non–institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25th–75th percentiles, $32.95–$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care.