2018 USA National Average Medicare Reimbursements

Reimbursement

PLEASE READ AND UNDERSTAND:

This information was retrieved from http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. It is provided as a courtesy for illustration purposes only. This does not in anyway guarantee actual payment. Your local insurers may pay under their own particular guidelines. Review all information with your medical billing professionals.

Urodynamics

+ 2018 CPT Codes

 

CPT Code Short Description 2018 Amounts
51726 Complex Cystometrogram Total Payment: $273.24
Professional Interpretation: $88.56
Technical Component: $184.68
51727 Cystometrogram with UPP Total Payment: $321.48
Professional Interpretation: $110.52
Technical Component: $210.96
51728 Cystometrogram with Voiding Pressure Total Payment: $327.60
Professional Interpretation: $108.72
Technical Component: $218.88
51729 Cystometrogam with UPP and Voiding Pressure Total Payment: $351.72
Professional Interpretation: $131.04
Technical Component: $220.68
51741 Electro-uroflowmetry, First Total Payment: $16.20
Professional Interpretation: $8.61
Technical Component: $7.54
51784 Anal/Urinary Muscle Study Total Payment: $71.28
Professional Interpretation: $38.88
Technical Component: $32.40
51797 Intraabdominal Pressure Test Total Payment: $116.64
Professional Interpretation: $41.76
Technical Component: $74.88
51701 Insert Bladder Catheter Total Payment: $48.60
51798 Ultrasound Bladder Capacity Total Payment: $16.20

+ Video Urodynamics

CPT CODE SHORT DESCRIPTION 2018 AMOUNTS
51600 Injection for Bladder X-ray Total Payment: $189.36
74430 Contrast X-ray, Bladder Total Payment: $38.88
Professional Interpretation: $16.56
Technical Component: $22.32
74455 X-ray, Urethra/Bladder Total Payment: $83.88
Professional Interpretation: $16.92
Technical Component: $66.96
76000 Fluoroscope Examination Total Payment: $48.60
Professional Interpretation: $9.00
Technical Component: $39.60

+ Medicare Reimbursements

If Doctor Performs Complex CMG with Voiding Pressure Study, EMG and Uroflow

Total Reimbursement per Patient: $487.98

Procedure CPT Code Reimbursement Calculation Fee
Complex CMG with Voiding Pressure Study 51728 $327.60 @ 100% $327.60
Uroflow 51741-51 $16.15 @ 50% $8.10
EMG 51784-51 $71.28 @ 50% $35.64
Voiding Pressure Test 51797* $116.64 @ 100% $116.64

If Doctor Performs Complex CMG with Voiding Pressure Study, Urethral Pressure Profile Study, EMG and Uroflow

Total Reimbursement per Patient: $512.10

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Complex CMG with Voiding Pressure Study & UPP 51729 $351.72 @ 100% $351.72
Uroflow 51741-51 $16.20 @ 50% $8.10
EMG 51784-51 $71.28 @ 50% $35.64
Voiding Pressure Test 51797* $116.64 @ 100% $116.64

*Code 51797 can only be billed if also billing either 51728 or 51729. 51797 is not billed with a -51 modifier as it is an add-on code to 51728 or 51729.

Anorectal Manometry

+ 2018 CPT Codes

CPT CODE SHORT DESCRIPTION 2018 AMOUNTS
91120 Rectal Sensation, Tone and Compliance Test Total Payment: $435.60
Professional Interpretation: $51.12
Technical Component: $384.48
91122 Anorectal Manometry Total Payment: $235.80
Professional Interpretation: $92.88
Technical Component: $142.92
51784 Anal/Urinary Muscle Study, EMG Total Payment: $71.28
Professional Interpretation: $38.88
Technical Component: $32.40

+ Medicare Reimbursements

Doctor Owns the Equipment

Total Reimbursement per Patient: $589.14

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Rectal Sensation and Compliance 91120 $435.60 @ 100% $435.60
Anorectal Manometry 91122-51 $235.80 @ 50% $117.90
Anal/Urinary Muscle Study, EMG 51784-51 $71.28 @ 50% $35.64

Hospital Owns the Equipment

Total Reimbursement per Patient: $117.18

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Rectal Sensation and Compliance 91120 $51.12 @ 100% $51.12
Anorectal Manometry 91122-26 $92.88 @ 50% $46.44
Anal/Urinary Muscle Study, EMG 51784-26 $38.88 @ 50% $19.44

Other Codes

CPT CODE SHORT DESCRIPTION 2017 AMOUNTS
76872 Transrectal ultrasound Total Payment: $99.00

Professional Interpretation: $34.56
Technical Component: $64.44

95907 1-2 Motor or Sensory nerve conduction study Total Payment: $100.08
Professional Interpretation: $55.08
Technical Component: $45.00

ICD-10 Codes

+ Sample Codes for Common Related Conditions

CODE DESCRIPTION
N32.3 Diverticulum of bladder / Diverticulitis of bladder
N32.81 Overactive bladder
N35 Urethral stricture
N36.1 Urethral diverticulum
N36.4 Urethral functional and muscular disorders
N36.42 Intrinsic sphincter deficiency (ISD)
N36.44 Muscular disorders of urethra
N39.0 Urinary tract infection, site not specified
N39.3 Stress incontinence; use additional code to identify overactive bladder or detrusor muscle hyperactivity
N39.41 Urge incontinence
N39.44 Nocturnal enuresis
N39.46 Mixed incontinence
N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS)
R33 Retention of urine
R35 Polyuria, Frequency of micturition, Nocturia
R35.0 Urinary frequency
R35.1 Nocturia
R39.11 Hesitancy of micturition
R39.12 Poor urinary stream
R39.14 Feeling of incomplete bladder emptying
R39.15 Urgency of urination
R39.16 Straining to void
R39.81 Functional urinary incontinence
K59 Other functional intestinal disorders
K59.0 Constipation
K59.1 Functional diarrhea
K59.2 Neurogenic bowel, not elsewhere classified
K59.3 Megacolon, not elsewhere classified
K59.8 Other specified functional intestinal disorders
K59.9 Functional intestinal disorder, unspecified
K60 Fissure and fistula of anal and rectal regions
K62.9 Disease of anus and rectum, unspecified
K59 Other functional intestinal disorders

GI

+ 2018 CPT Codes

Reimbursement For GI Diagnostics

CPT CODE SHORT DESCRIPTION 2018 AMOUNTS
91010 Esophageal Motility Study Total Payment: $181.08
Professional Interpretation: $68.76
Technical Component: $112.32
91013 Esophageal Motility w/stim/perfus Total Payment: $25.92
Professional Interpretation: $9.72
Technical Component: $16.20
91013 Duodenal Motility Study Total Payment: $173.52
Professional Interpretation: $77.04
Technical Component: $96.48
91034 Gastroesophageal reflux test Total Payment: $192.60
Professional Interpretation: $52.20
Technical Component: $140.40
91037 Esophageal impedance function test Total Payment: $165.24
Professional Interpretation: $51.84
Technical Component: $113.40
91038 Esophageal impedance function test <1 hr Total Payment: $459.35
Professional Interpretation: $59.04
Technical Component: $400.32
91117 Colonic Manometry Total Payment: $143.28
91120 Rectal sensation, tone, and compliance test Total Payment: $435.60
Professional Interpretation: $51.12
Technical Component: $384.48
91122 Anorectal Manometry Total Payment: $235.80
Professional Interpretation: $92.88
Technical Component: $142.92
51784 Anal/urinary muscle study, EMG Total Payment: $71.28
Professional Interpretation: $38.88
Technical Component: $32.40
76872 Transrectal ultrasound Total Payment: $99.00
Professional Interpretation: $34.56
Technical Component: $64.44
95907 1-2 Motor or Sensory nerve conduction study Total Payment: $100.08
Professional Interpretation: $55.08
Technical Component: $45.00
43263 ERCP with pressure measurement Total Payment: $378.36
90911 Biofeedback incl EMG and/or manometry Total Payment: $88.56
99211 Office/outpatient visit Total Payment: $21.96
91020 Gastric Motility Studies Total Payment: $241.20
Professional Interpretation: $77.04
Technical Component: $164.16
91065 Breath hydrogen/methane test Total Payment: $73.80
Professional Interpretation: $10.44
Technical Component: $63.36

gi ICD-10 Codes

+ Sample Codes for Common Related Conditions

CODE DESCRIPTION
K21.0 Gastro-esophageal reflux disease with esophagitis
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0 Achalasia of cardia
K30 Functional dyspepsia
K52.2 Allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.13 Vomiting of fecal matter
R11.14 Bilious vomiting
R11.2 Nausea with vomiting, unspecified
R12 Heartburn
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R14.0 Abdominal distension (gaseous)
R14.1 Gas pain
R14.2 Eructation
R14.3 Flatulence
R15.0 Incomplete defecation
R15.1 Fecal smearing
R15.2 Fecal urgency
R15.9 Full incontinence of feces
R19.11 Absent bowel sounds
R19.12 Hyperactive bowel sounds
R19.15 Other abnormal bowel sounds
R19.2 Visible peristalsis
R19.4 Change in bowel habit
R19.5 Other fecal abnormalities
R19.7 Diarrhea, unspecified
R19.8 Other specified symptoms and signs