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See a sample rate comparisonCPT 91040 Fee Schedule
Last Verified: October 2026
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.
Esophagus Balloon Test, Esophagus Balloon Test. The Test Involves Placing A Balloon In The Esophagus And Inflating It To Produce Chest Pain. It Is Used To Differentiate Between Chest Pain Caused By Irritation To The Esophagus And Chest Pain That Is Associated With Heart Problems.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Gastroenterology Procedures |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $576.83 national non-facility rate (2026) · View Medicare rates for 91040 |
| Medicaid Fee Schedule | $474.035 median of the 8 states in the free preview · View Medicaid rates for 91040 |
National average reimbursement for CPT 91040 by major payers:
$572.17
$586.88
$659.38
$779.22
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CPT 91040
5 of 25 sample ratesHigher to lower in this preview
Grand Strand Regional Medical Center, LLC, Grand Strand Medical Center
Grand Strand Regional Medical Center LLC
$6,583.00Published rateHmh Hospitals Corporation, Bayshore Medical Center
Hackensack Meridian Health Inc
$3,072.00Published rateWesley Medical Center LLC, Wesley Medical Center
Wesley Medical Center LLC
$1,567.00Published rateEast Texas Medical Center Athens
$551.00Published rateCounty Of Ward, Ward Memorial Hospital
$189.00Published rate
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See a sample payer proposalCPT 91040 vs. Other Gastroenterology Procedures Codes
The CPT 91040 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 91040 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 |
|---|---|---|
| 91035-CPT | Moderate | G Esoph Reflx Tst W Electrod, Esophagus Gastroesophageal Reflux Test With Mucosal Attached Telemetry Ph Electrode Placement Recording Analysis And Interpretation |
| 91037-CPT | Low | Esophageal Function Test Gast, Esophageal Function Test Gastroesophageal Reflux Test With Nasal Catheter Intraluminal Impedance Electrode(S) Placement Recording Analysis And Interpretation |
| 91038-CPT | Moderate | Esoph Imped Funct Test 1hr, Esophageal Function Test Gastroesophageal Reflux Test With Nasal Catheter Intraluminal Impedance Electrode S Placement Recording Analysis And Interpretation Prolonged Greater Than 1 Hour Up To 24 Hours |
| 91040-CPT | Moderate | Esophagus Balloon Test, Esophagus Balloon Test. The Test Involves Placing A Balloon In The Esophagus And Inflating It To Produce Chest Pain. It Is Used To Differentiate Between Chest Pain Caused By Irritation To The Esophagus And Chest Pain That Is Associated With Heart Problems. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91040 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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