Summary & Overview
CPT 91010: Esophageal Manometry with Interpretation and Report
CPT code 91010 covers diagnostic esophageal manometry in which a provider uses a manometer to measure esophageal muscle pressure and motility, interprets the findings, and produces a formal report. This test is commonly used in the evaluation of gastroesophageal reflux disease (GERD) and other esophageal motility disorders; accurate documentation of interpretation and reporting is central to clinical decision-making and appropriate billing. Nationally, esophageal manometry is an established diagnostic tool in gastroenterology and factors such as site-of-service, documentation of interpretation, and payer-specific coverage rules influence reimbursement and utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 91010, typical sites of service, and the types of documentation that support reporting. The publication also summarizes payer coverage considerations, common modifiers associated with procedural and professional components, and related billing topics relevant to coding integrity. This resource is intended for billing professionals, gastroenterology clinicians, and policy analysts seeking a national overview of how CPT code 91010 is used and reported.
Billing Code Overview
CPT code 91010 describes the use of a manometer to measure and analyze esophageal muscle pressure and motility. The procedure includes interpretation of the recorded measurements by the provider and preparation of a written report summarizing the findings.
Service Type: Diagnostic esophageal manometry with interpretation and report
Typical Site of Service: Outpatient gastroenterology clinic or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient with persistent heartburn, regurgitation, and poor response to proton pump inhibitor therapy is referred to a gastroenterologist for esophageal physiologic testing. The provider schedules esophageal manometry to evaluate esophageal motility and lower esophageal sphincter function to distinguish gastroesophageal reflux disease-related dysmotility from primary motility disorders. On the day of service the patient arrives at an outpatient ambulatory surgery center. A registered nurse prepares the patient, topical anesthetic is applied, and a transnasal manometry catheter is passed into the esophagus. The provider performs standardized wet swallows while recording pressures, interprets the findings, documents the study in the medical record, and prepares a formal written report for the referring clinician. The final report includes integrated interpretation of sphincter pressures, peristaltic integrity, and any clinically significant abnormalities relevant to management of GERD and dysphagia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician interpretation/report separate from technical performance |
59 | Distinct procedural service |