CPT 91034 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 91034 by major payers:
$236.68
$252.73
$258.27
$328.21
| 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 91034 | ||||||
United | 91034 | $65.77 | 1891180170 - SURYA SABHAPATHY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 91034 | $285.92 | 1760923916 - LUKE PETRY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 91034 | $143.27 | 1528599222 - THOMAS WOOL | 630691533 - (AL) MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91034 | $53.31 | 1457358053 - M. AHMED | 203730869 - (AL) RIVER REGION CARDIOLOGY ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91034 | $179.61 | 1174781017 - KEVIN DEANDRADE | 631159436 - (AL) MOBILE HEART SPECIALISTS, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91034 | $133.08 | 1851400485 - GEORGE HEMSTREET | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91034 | $381.00 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $96.94 | 1205874450 - THOMAS NOGUEIRA | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 91034 | $96.94 | 1629401187 - JESSE HINTON | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 91034 | $1873.00 | 1043267701 - COLUMBIA VALLEY HEALTHCARE SYSTEM, L.P., VALLEY REGIONAL MEDICAL CENTER | 621669572 - (TX) COLUMBIA VALLEY HEALTHCARE SYSTEM LP | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $64.25 | 1316931835 - WILBARGER COUNTY HOSPITAL DISTRICT, WILBARGER GENERAL HOSPITAL | 756047638 - (TX) WILBARGER GENERAL HOSPITAL EMPLOYEE BENEFIT PLAN | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $63.56 | 1922058569 - SAN ANTONIO VAMC | 742112082 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $235.00 | 1326079534 - CHILDRESS COUNTY HOSPITAL DISTRICT, CHILDRESS REGIONAL MEDICAL CENTER | 751228349 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $257.41 | 1275633604 - EL PASO VAMC | 742934770 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $242.99 | 1447670500 - DEREK ZIPKIN | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | IN | Diagnostic Radiology Physician (2085R0202X) |
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 91034 vs. Other Gastroenterology Procedures Codes
The CPT 91034 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 91034 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 |
| 91034-CPT | Moderate | Esophagus, Gastroesophageal Reflux Test; With Nasal Catheter Ph Electrode(S) Placement, Recording, Analysis And Interpretation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91034. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91034 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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