HCPCS Codes, Healthcare Common Procedure Coding System numbers, are the codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services. They are based on the CPT Codes(Current Procedural Technology codes) developed by the American Medical Association.

CPT insurance codes

HCPCS Codes  ensure uniformity as they are numbers assigned to every task and service a medical practitioner may provide to a Medicare patient including medical, surgical and diagnostic services.

Medicare approves payment for the following:

Four HCPCS codes (Common Procedure Coding System codes) are payable by Medicare for ABPM for suspected white coat hypertension:
ABPM, utilizing a system such as magnetic tape and/or computer disk, for 24 hrs or longer,
■ including recording, scanning analysis, interpretation and report, or
■ recording only, or
■ scanning analysis with report, or
■ physician review with interpretation and report.

Clinical indications for ABPM

The only diagnosis covered by Medicare is elevated blood pressure reading without diagnosis of hypertension
ABPM is only payable for patients with suspected “white coat hypertension” (WCH).
Note:
● this is designated as an outpatient service
● ABPM must be performed for at least a 24-hour time period
● patients admitted to a hospital or residing in institutions (such as SNFs) who receive ABPM are not qualified for coverage
● if ABPM must be performed more than once for a particular beneficiary, the qualifying criteria (described in the Reimbursement section) must be met for each subsequent ABPM test.

Private insurance providers reimburse for further diagnoses:

- Elevated blood pressure reading without diagnosis of hypertension
- The ONLY ICD-code reimbursed by Medicare
- Essential hypertension
- Benign hypertension
- Essential hypertension – Unspecified (Resistant)
- Hypertensive heart disease
- Benign hypertensive heart disease
- Benign hypertension without congestive
- Unspecified hypertensive heart disease
- Unspecified hypertension without congestive heart failure
- Hypertensive renal disease
- Nocturnal angina
- Ill-defined descriptions and complications of heart disease
- Orthostatic hypotension
- Unspecified hypotension
- Hypertension complicating pregnancy, childbirth and puerperium
- Transient hypertension of pregnancy
- Mild or unspecified preeclampsia
- Unspecified hypertension complicating pregnancy
- Maternal hypotension syndrome
- Syncope or collapse
- Other hypertension (Episodic, Labile, Postural)


For specific codes and more information please refer to Medicare, AMA, CMS or your provider.