Your Holter ABPM pays for itself
Up to 350$ reimbursement after each test in the USA!
Using a Holter ABPM is becoming increasingly popular in general practices, because, in comparision to conventional blood pressure monitors, this type of technique provides more detailed information. Using a Holter ABPM may seem to be costly at first sight, but the device pays for itself as ambulatory blood pressure monitoring is a reimbursable proceedure. In the USA Medicare will reimburse an ambulatory blood pressure monitoring equipment test only in case of suspected white coat hypertension, while other private insurance carriers may reimburse for additional indications as well.
Medicare indications and limitations of coverage
The Holter ABPM test should last at least 24 hours. Coverage is valid only in case of suspected white coat hypertension, which can be diagnosed only if the below listed conditions are met.
1. Office blood pressure is above 140/90 mmHg at least three office visits with two independent measurement made at each visit.
2. Minimum two documented blood pressure measurements taken outside the office environment which are above 140/90 mmHg.
3. There is no evidence of end-organ damage.
For more information you can visit Centers for Medicare & Medicaid Services.
Possible indications of reimbursing a Holter ABPM test at private insurance providers
1. Exclusion of white coat hypertension
2. Masked hypertension
3. Hypertensive patients resistant to treatment
4. Identification of nocturnal hypertension
5. Diagnosis of hypotension
Reimbursement is between 60$-225$, depending on whether the service provider is Medicare or other private insurance carriers.
Holter ABPM reimbursement codes
Reimbursement codes create a common language between doctors, patients and insurance providers. There are two types of codes: ICD-9 and CPT.
ICD-9 (International Classification of Diseases, 9th Revision)
It is a system which codes the diagnosis of the patient's conditions or disease. Medicare will reimburse only under code 796.2, while private insurance providers may reimburse under additional ICD-9 codes, such as:
|Condition or disease||ICD-9|
|Essential hypertension (incl. high blood pressure, hyperpiesia, hyperpiesis, hypertension, hypertensive vascular degeneration, disease)||401|
|Hypertensive heart disease (incl. hyperensive cardiomegaly, cardiopathy, cardiovascular disease, heart disease, failure, any condition classifiable 429.0-429.3, 429.8, 429.9 due to hypertension, use additional code to specify type of heart failure (428.0-428-43), if known.||402|
|Hypertensive chronic kidney disease (incl. arteriolar nephritis, arteriosclerosis of kidney, renal arterioles, arteriosclerotic nephritis, hypretensive nephropathy, renal failure, uremia, nephrosclerosis, renal sclerosis with hypertension and any condition classifiable to 585 with any condition classifiable to 401)||403|
|Hypertensive heart and chronic kidney disease (incl. cardiorenal, cardiovascular renal disease, any condition classifiable to 402 with any condition classifiable to 403, use additional code to specify type of heart failure (428.0-428.43), if known.||404|
|Angina decubitus (nocturnal angina)||413.0|
|Hypotension (incl. hypopiesis)||458|
|Hypertension complicating pregnancy, childbirth and the puerperium||642|
|Maternal hypotension syndrome||669.2|
|Elevated blood pressure reading without diagnosis of hypertension||796.2|
For more accurate information please visit ICD9.chrisendres.com
CPT (Current Procedural Terminology)
The 5-digit CPT codes are published by the American Medical Association to precisely define the treatment and services provided for the diagnosis.
|93784||ABPM, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report||04/01/2002|
|93786||ABPM, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only.||04/01/2002|
|93788||ABPM, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report.||01/01/2004|
|93790||ABPM, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; physician review with interpretation and report||04/01/2004|