CPT 91010 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Gastroenterology Procedures |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 91010 by major payers:
$251.18
$250.12
$282.69
$334.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 91010 | ||||||
United | 91010 | $75.02 | 1548502412 - SAMI ADIB | 932832107 - (TX) GASTROMEDCONNECT PLLC | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $264.00 | 1033378195 - THUC QUYEN NGUYEN | 751976930 - (TX) MOTHER FRANCES HOSPITAL JACKSONVILLE | SC | Gastroenterology Physician (207RG0100X) |
United | 91010 | $289.29 | 1184801359 - JORGE CAVAZOS | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $263.00 | 1053378448 - JAYAPRAKASH SREENARASIMHAIAH | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $112.55 | 1265669394 - NAVYA KANURI | 742958277 - SCOTT & WHITE CLINIC | IN | Gastroenterology Physician (207RG0100X) |
United | 91010 | $194.92 | 1811007883 - JAY YEPURI | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $82.51 | 1881699734 - RICHARD OTERO | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $61.56 | 1790296812 - MIDLAND GASTROENTEROLOGY AND HEPATOLOGY, P.A. | 822973053 - (TX) MIDLAND GASTROENTEROLOGY AND HEPATOLOGY PA | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $234.72 | 1659515914 - DIGESTIVE CENTER ASSOCIATES | 262466786 | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $141.75 | 1770739211 - DZIFAA LOTSU | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | OH | Gastroenterology Physician (207RG0100X) |
United | 91010 | $110.00 | 1902494743 - TEXAS MODERN GASTROENTEROLOGY | 861246200 - (TX) TEXAS MODERN GASTROENTEROLOGY | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $301.50 | 1346616851 - TUGRUL PURNAK | 760459500 - U T PHYSICIANS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $90.76 | 1861696452 - RAMESH SRINIVASAN | 752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS | TX | Gastroenterology Physician (207RG0100X) |
United | 91010 | $308.63 | 1265450811 - HUSSIEN ELSIESY | 260209018 - (CO) GASTROENTEROLOGY ASSOCIATES OF WESTERN COLORADO | CO | Gastroenterology Physician (207RG0100X) |
United | 91010 | $339.42 | 1629509864 - CICILY VACHAPARAMBIL | 742958277 - SCOTT & WHITE CLINIC | GA | Gastroenterology Physician (207RG0100X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 91010 vs. Other Gastroenterology Procedures Codes
The CPT 91010 code is part of the Medicine Services and Procedures services used for Gastroenterology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 91010 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 91010-CPT | Moderate | Esophageal Motility (Manometric Study Of The Esophagus And/Or Gastroesophageal Junction) Study With Interpretation And Report; 2-Dimensional Data |
| 91013-CPT | Low | Esophageal Motility (Manometric Sturdy Of The Esophagus And/Or Gastroesophageal Junction) Study With Interpretation And Report; With Stimulation Or Perfusion During 2-Dimensional Data Study (Eg Stimulant Acid Or Alkali Perfusion)(List Separately In Addition To Code For Primary Procedure) |
| 91020-CPT | Moderate | Esophagogastric Manometric Studies |
| 91022-CPT | Moderate | Duodenal Motility Study |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91010. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91010 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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