OBJECTIVES: Ambulatory blood pressure monitoring (ABPM) is recommended for identification of white coat hypertension (WCH). However, reimbursement in the United States is variable and overall quite low compared to other advanced healthcare systems. We examined the reimbursement of different components of ABPM and factors associated with successful reimbursement in commercially-insured Americans.

METHODS: A retrospective analysis of Truven Commercial claims database was conducted for patients ≥18 years old with ABPM from January 2012 to December 2016. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was used as the index date. Beneficiaries with 12 months of continuous enrollment pre-index and 30-days post-index were included. Per-beneficiary ABPM episode reimbursements were calculated by aggregating all ABPM-related reimbursements within the 30-day post-index window. Multivariable logistic regression was used to identify predictors of successful reimbursement.

RESULTS: Of 20,875 beneficiaries with ABPM claims, 16,920 (81.05%) were reimbursed. Among reimbursed claims, only 50% contained a WCH diagnosis code. The mean reimbursement per beneficiary for an ABPM episode was $126 (standard deviation=166). For full component ABPM, the median reimbursement was $82 (n=12,785; interquartile range[IQR], $64,$103). Among different components of ABPM, the highest median reimbursement was obtained for scan analysis & report claims at $133 (n=1,473; IQR, $70,$240). benefit plan types, Consumer Directed Health Plans provided the highest median reimbursement ($85; IQR, $47,$138). Successful reimbursement was associated with female patient sex (OR:1.20, 95%CI:1.11-1.28), claim filing by a specialist (OR:1.27, 95%CI:1.15-1.40) and services provided at the outpatient hospital (OR:1.16, 95% CI:1.01-1.34).

CONCLUSIONS: Considering ABPM to be a gold standard to identify WCH, more uniform criteria for ABPM reimbursement may facilitate greater use of recommended monitoring. Full ABPM procedures were reimbursed at lower rates than two of the component procedures, which may be related to different insurers approaches to reimbursing ABPM, although further research is needed.