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 |
| Medicare Fee Schedule | View Medicare rates for 91034 |
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 | $2960.00 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1571.00 | 1871599183 - FORT WORTH SURGICARE PARTNERS, LTD., BAYLOR SCOTT & WHITE SURGICAL HOSPITAL - FORT WORTH | 752658178 - (TX) FORT WORTH SURGICARE PARTNERS LTD | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1201.00 | 1619115383 - ASCENSION SETON, ASCENSION SETON HAYS | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1138.00 | 1487706214 - IASIS GLENWOOD REGIONAL MEDICAL CENTER LP | 205249827 - (LA) IASIS GLENWOOD REGIONAL MEDICAL CENTER LP | LA | General Acute Care Hospital (282N00000X) |
United | 91034 | $339.92 | 1003860024 - EUGENE PAIK | 310667480 - (OH) PROFESSIONAL RADIOLOGY, INC. | OH | Diagnostic Radiology Physician (2085R0202X) |
United | 91034 | $318.63 | 1679557888 - CHRISTUS HEALTH SOUTHEAST TEXAS, CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH | 760591590 - (TX) CHRISTUS HEALTH SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $730.00 | 1467442418 - NORTHWEST TEXAS HEALTHCARE SYSTEM INC, NORTHWEST TEXAS HEALTHCARE SYSTEM | 232238976 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $931.00 | 1164526786 - ASCENSION SETON, ASCENSION SETON MEDICAL CENTER AUSTIN | 741109643 - ASCENSION SETON | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $300.00 | 1689650921 - EASTLAND MEMORIAL HOSPITAL DISTRICT, EASTLAND MEMORIAL HOSPITAL | 752313255 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $2731.00 | 1740233782 - MEMORIAL HERMANN HEALTH SYSTEM, MEMORIAL HERMANN MEMORIAL CITY HOSPITAL | 741152597 - (TX) MEMORIAL HERMANN HEALTH SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1444.00 | 1265772362 - SCOTT & WHITE HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - COLLEGE STATION | 274434451 - (TX) SCOTT & WHITE HOSPITAL - COLLEGE STATION | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $303.29 | 1730556259 - RAM SAHA | 541581185 - MCV ASSOCIATED PHYSICIANS | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1085.00 | 1245201656 - TEXAS INSTITUTE FOR SURGERY, LLP, TEXAS INSTITUTE FOR SURGERY AT TEXAS HEALTH PRESBYTERIAN DALLAS | 770628004 - (TX) TEXAS INSTITUTE FOR SURGERY, LLP | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1225.00 | 1700885076 - TH HEALTHCARE, LTD, NACOGDOCHES MEDICAL CENTER | 760354630 | TX | General Acute Care Hospital (282N00000X) |
United | 91034 | $1143.00 | 1114473329 - EMERUS BHS SA THOUSAND OAKS LLC, BAPTIST NEIGHBORHOOD HOSPITAL SHAVANO PARK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
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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