CPT 91040 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 91040 by major payers:
$572.17
$586.88
$659.38
$795.07
| 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 91040 | ||||||
United | 91040 | $410.63 | 1235771205 - AKUMIN IMAGING TEXAS LLC | 364793204 - (TX) AKUMIN INC. | TX | Radiology Clinic/Center (261QR0200X) |
United | 91040 | $3990.00 | 1619938016 - DANBURY HOSPITAL, DANBURY HOSPITAL DBA NEW MILFORD HOSPITAL | 60646597 - DANBURY HOSPITAL | CT | General Acute Care Hospital (282N00000X) |
United | 91040 | $514.47 | 1083851471 - ONE STEP DIAGNOSTIC III, L.P., FALLBROOK OPEN MRI | 205847693 | TX | Radiology Clinic/Center (261QR0200X) |
United | 91040 | $415.00 | 1790785913 - TRINITAS REGIONAL MEDICAL CENTER, TRINITAS HOSPITAL - AMBULANCE | 223601678 - (NJ) RWJ BARNABAS HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91040 | $1567.00 | 1447299649 - WESLEY MEDICAL CENTER LLC, WESLEY MEDICAL CENTER | 621762545 - (KS) WESLEY MEDICAL CENTER LLC | KS | General Acute Care Hospital (282N00000X) |
United | 91040 | $1011.00 | 1992131734 - DIGNITY HEALTH, ST. JOSEPH'S WESTGATE MEDICAL CENTER | 721561134 - (AZ) ST JOSEPHS HOSPITAL AND MEDICAL CENTER | AZ | General Acute Care Hospital (282N00000X) |
United | 91040 | $382.00 | 1225514599 - GULF HEALTH HOSPITALS, INC, NORTH BALDWIN INFIRMARY | 630891904 - (AL) GULF HEALTH HOSPITALS INC | AL | General Acute Care Hospital (282N00000X) |
United | 91040 | $189.00 | 1720096019 - COUNTY OF WARD, WARD MEMORIAL HOSPITAL | 756001193 | TX | Critical Access Hospital (282NC0060X) |
United | 91040 | $2622.00 | 1073504528 - SOUTHERN OCEAN COUNTY HOSPITAL | 221487576 - HACKENSACK MERIDIAN HEALTH INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91040 | $2224.00 | 1568553519 - SILVER CROSS HOSPITAL & MEDICAL CENTERS, SILVER CROSS HOSPITAL | 362174832 - (IL) SILVER CROSS HOSPITAL & MEDICAL CENTERS | IL | General Acute Care Hospital (282N00000X) |
United | 91040 | $2172.00 | 1417037045 - MOUNT CARMEL HEALTH SYSTEM | 311439334 - MOUNT CARMEL HEALTH SYSTEM | OH | General Acute Care Hospital (282N00000X) |
United | 91040 | $1866.00 | 1982733655 - DIGNITY HEALTH, ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER | 463533638 - (AZ) DIGNITY HEALTH | AZ | General Acute Care Hospital (282N00000X) |
United | 91040 | $6583.00 | 1477630598 - GRAND STRAND REGIONAL MEDICAL CENTER, LLC, GRAND STRAND MEDICAL CENTER | 621768105 - (SC) GRAND STRAND REGIONAL MEDICAL CENTER LLC | SC | General Acute Care Hospital (282N00000X) |
United | 91040 | $1470.00 | 1750819025 - NORTH HOUSTON, HCA HOUSTON HEALTHCARE TOMBALL | 821349955 | TX | General Acute Care Hospital (282N00000X) |
United | 91040 | $3828.00 | 1770515991 - GOOD SAMARITAN MEDICAL CENTER, INC., GOOD SAMARITAN MEDICAL CENTER | 752932824 | FL | 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 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 |
|---|---|---|
| 91034-CPT | Moderate | Esophagus, Gastroesophageal Reflux Test; With Nasal Catheter Ph Electrode(S) Placement, Recording, Analysis And Interpretation |
| 91035-CPT | Moderate | Esophagus, Gastroesophageal Reflux Test; With Mucosal Attached Telemetry Ph Electrode Placement, Recording, Analysis And Interpretation |
| 91037-CPT | Low | Esophageal Function Test, Gastroesophageal Reflux Test With Nasal Catheter Intraluminal Impedance Electrode(S) Placement, Recording, Analysis And Interpretation; |
| 91040-CPT | Moderate | Esophageal Balloon Distension Provocation Study |
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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