ABPM Reimbursement in the US

As a follow-up to the previous post about hypertension neglect in the US, I wanted to provide a bit more information about ambulatory blood pressure monitoring (ABPM). As we've discussed in previous blog posts, ambulatory blood pressure monitoring is a commonly-used tool for the identification and treatment of hypertension. Many health care providers are still unaware that ABPM is a reimbursable procedure although Medicare approved reimbursement in 2001. Routine use of ABPM can serve as a source of revenue for physicians while also improving the quality of care for patients.

Reimbursement Information

Medicare reimburses ABPM testing for suspected white-coat hypertension,(ICD-9 code 796.2), but private insurance carriers may reimburse for additional indications. Aetna, for example, reimburses for the following indications: white coat hypertension, resistant hypertension, hypotension, nocturnal angina, episodic hypertension, and evaluation of syncope. For more information on reimbursement documentation requirements, CPT and ICD-9 codes, and billing, check out this ABPM Reimbursement FAQ sheet.

ABPM as a Source of Revenue

Studies show that 15-20% of the adult population has white-coat hypertension (WCH), so several patients per day are eligible for ABPM testing, especially those newly diagnosed with hypertension. Medicare reimbursement generally varies between $60 and $120 while private insurance carriers reimburse between $75 and $225 per ABP test, but reimbursement amounts vary by region. With these reimbursement rates, return on investment analysis shows the payback period for an ABP device is quite short, even with minimal testing on one patient per week.

ROI Schedule for an ABP device ($2600)

Research shows ABPM is superior to office and home BP as a hypertension diagnostic and treatment tool. While ABPM is the gold standard for hypertension management, it can also improve efficiency in the treatment of hypertension. Recording several office measurements requires a quiet room, so the patient is taking up office time and space that could be used for other paying patients. Home BP can be unreliable, as patients may skew the self-reporting of readings. Some new home BP devices now have software and memory capability to improve patient reporting, but ABPM is more reliable and provides night-time readings. ABPM requires minimal in-office patient time while also providing several BP data points, improving the quality of care and office workflow in the treatment of hypertension.

Cost Effective Tool for Hypertension Management

In addition to creating a new source of revenue for physicians, ABPM is also a cost-effective solution for the health care system. Ambulatory monitoring performed on an annual basis as a secondary screening for hypertension can create cost savings when treatment costs are as little as $300. Patients may also be interested in paying for an ABPM test out of pocket, as it can be more cost effective than paying for hypertension treatment. Children have a higher incidence of WCH than adults, reported at anywhere from 44 - 53%, making ABPM testing even more beneficial for the pediatric population. Patients diagnosed with stage 1 hypertension who were identified as WCH through ABPM saved over 50% in medical costs. As discussed in the previous blog post, ABPM is a cost-effective tool that should be better integrated into the health care system to improve the quality of care for hypertensive patients.

1 AHA Scientific Statement: Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment.

2 Pickering, TG, Shimbo, D, and Haas, D. (2006). Ambulatory Blood-Pressure Monitoring. New England Journal of Medicine, 354, 2368-2374.

3 Krakoff, LR. (2006). Cost-Effectiveness of Ambulatory Blood Pressure. Hypertension, 47, 29-34.

4 Swartz, S, Srivaths, P, Croix, B and Feig D. (2008). Cost-Effectiveness of Ambulatory Blood Pressure Monitoring in the Initial Evaluations of Hypertension in Children. Pediatrics, 122, 1177 - 1181.