Medical insurance reimbursement is an important issue for all medical diagnostic tests. It is a question that is useful to be considered in deciding when and how to incorporate ABPM as part of a practice.
In recent years, ambulatory blood pressure monitors (ABPM) have become commonly used devices in the diagnosis and management of hypertension, thanks to the Center for Medicare and Medicaid Services (CMS), that began reimbursement of ABPM for evaluation of “white-coat” hypertension in 2001.

Reimbursement for 24 hour ambulatory BP measurement

Ambulatory blood pressure monitoring is currently a reimbursable procedure by both Medicare and private insurance providers, with reimbursement rates varying between $59-$122 for Medicare and $50-$300 for private insurance carriers. Rates for reimbursement vary depending on geographical region, insurance company policies as well as patient conditions.

Medicare covers an ABPM test for suspected white coat hypertension  (WCH) only. To be covered, ABPM must be performed for at least a 24-hour time period.

Physician guidelines developed by HCFA/CMS:
- clinic/office blood pressure elevated (>140/90 mmHg) at 3 separate clinic/office visits with two separate measurements made at each visit.
- at least two BP measurements taken outside the clinic/office which are <140/90 mmHg
- no evidence of end-organ damage

The amount of reimbursement can vary by region.  Please contact your Medicare contractor to specify the exact amounts for your region.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM2726.pdf
http://www.cms.hhs.gov/Transmittals/downloads/R109CP.pdf

Private Insurance Providers may reimburse for a wider range of indications, including:
- evaluation of anti-hypertensive therapy
- resistant hypertension
- episodic hypertension
- arrhythmia
- evaluation of syncope
- gestational hypertension/preeclampsia.
- nocturnal angina
- autonomic dysfunction
- masked hypertension
- failed home BP management, etc.

Of course, not all providers cover all conditions. Coverage indications and reimbursement rates vary by provider, contractual agreements, and for each state.

Please contact your provider representative for your contracted indications and rates.