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 | $550.40 | 1760429831 - BRUCE MADSEN | 260210091 - (OR) BRIDGEPORT EYE PHYSICIANS LLC | OR | Ophthalmology Physician (207W00000X) |
United | 91040 | $1023.48 | 1851491187 - HIGHLANDS HOSPITAL AND HEALTH CENTER, HIGHLANDS HOSPITAL EMERGENCY DEPT PHYSICIANS | 251494705 - HIGHLANDS HOSPITAL AND HEALTH CENTER | PA | General Acute Care Hospital (282N00000X) |
United | 91040 | $1585.00 | 1902031180 - HENRY FORD WYANDOTTE | 382791823 - (MI) HENRY FORD WYANDOTTE HOSPITAL CORPORATION | MI | General Acute Care Hospital (282N00000X) |
United | 91040 | $1422.00 | 1164663365 - LONG ISLAND JEWISH MEDICAL CENTER | 112241326 - LONG ISLAND JEWISH MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 91040 | $356.00 | 1588770416 - VALLEY MEDICAL FACILITIES INC, VALLEY MEDICAL FACILITIES INC DBA HERITAGE VALLEY SEWICKLEY | 251801532 - (PA) HERITAGE VALLEY HEALTH SYSTEM | PA | General Acute Care Hospital (282N00000X) |
United | 91040 | $2277.00 | 1609983790 - MONMOUTH MEDICAL CENTER INC | 223452412 | NJ | General Acute Care Hospital (282N00000X) |
United | 91040 | $1211.00 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 91040 | $10536.00 | 1174576896 - PHYSICIAN MANAGEMENT, LTD. | 210634484 - (NJ) INSPIRA MEDICAL CENTERS INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91040 | $1661.00 | 1497843940 - BAPTIST HEALTH SYSTEM INC, WALKER BAPTIST MEDICAL CENTER | 474790386 | AL | 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 | $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 | $966.90 | 1639101751 - MASSACHUSETTS EYE AND EAR INFIRMARY | 42103591 - (MA) MASS GENERAL BRIGHAM INCORPORATED | MA | General Acute Care Hospital (282N00000X) |
United | 91040 | $719.00 | 1467521146 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. JOSEPH HOSPITAL - ST. CHARLES | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 91040 | $721.00 | 1629009964 - MERCY HEALTH YOUNGSTOWN LLC, MERCY HEALTH ST JOSEPH WARREN HOSPITAL | 340505560 - HUMILITY OF MARY HEALTH PARTNERS | OH | General Acute Care Hospital (282N00000X) |
United | 91040 | $1749.00 | 1245615772 - PARK NICOLLET METHODIST HOSPITAL, PN METHODIST HOSPITAL EPISODIC BUNDLE | 410132080 - (MN) PARK NICOLLET HEALTH SERVICES | MN | 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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