CPT CODES

CPT Code 91012

CPT code 91012 is a medical billing code used for an esophagus motility study, which evaluates how well the esophagus functions.

Table of Contents
What is CPT Code 91012
Does CPT 91012 Need a Modifier?
CPT Code 91012 Medicare Reimbursement
Are You Being Underpaid for 91012 CPT Code?
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What is CPT Code 91012

CPT code 91012 is a procedure that involves an esophageal motility study, which is used to evaluate the function of the esophagus. This test measures the pressure and pattern of muscle contractions in the esophagus as a patient swallows. It helps healthcare providers diagnose conditions related to swallowing difficulties, gastroesophageal reflux disease (GERD), and other esophageal disorders.

Does CPT 91012 Need a Modifier?

For CPT code 91012, which pertains to an esophagus motility study, the following modifiers may be applicable:

1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. For example, if a physician interprets the results of the esophagus motility study but does not own the equipment used for the test.

2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. For instance, if a facility provides the equipment and technical support for the esophagus motility study but does not include the physician's interpretation.

3. Modifier 52 - Reduced Services: This modifier is used when the service provided is less extensive than what is typically required. For example, if the esophagus motility study was partially completed due to patient intolerance or other factors.

4. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. For example, if the esophagus motility study had to be stopped because the patient experienced severe discomfort.

5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. For example, if the esophagus motility study was performed in conjunction with another diagnostic procedure, and it is necessary to show that they were separate and distinct services.

6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional. For example, if the esophagus motility study needed to be repeated on the same day due to initial inconclusive results.

7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional. For example, if the esophagus motility study was initially performed by one physician and then repeated by another for verification or further analysis.

8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results. For example, if the esophagus motility study needed to be repeated to monitor changes or confirm initial findings.

These modifiers help provide additional information about the circumstances under which the esophagus motility study was performed, ensuring accurate billing and reimbursement.

CPT Code 91012 Medicare Reimbursement

The CPT code 91012 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and reimbursement rates.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining local coverage and payment policies. Therefore, it is advisable to consult the relevant MAC for your region to confirm the specific reimbursement criteria and any potential local coverage determinations (LCDs) that may apply to CPT code 91012.

Are You Being Underpaid for 91012 CPT Code?

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