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 |
| 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 |