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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Kent, ST; Shimbo, D; Huang, L; Diaz, KM; Viera, AJ; Kilgore, M; Oparil, S; Muntner, P

Published Date

  • December 2014

Published In

Volume / Issue

  • 8 / 12

Start / End Page

  • 898 - 908

PubMed ID

  • 25492833

Pubmed Central ID

  • 25492833

Electronic International Standard Serial Number (EISSN)

  • 1878-7436

International Standard Serial Number (ISSN)

  • 1933-1711

Digital Object Identifier (DOI)

  • 10.1016/j.jash.2014.09.020

Language

  • eng