Summary & Overview
CPT 91013: Esophageal Manometry with Stimulation or Perfusion
CPT code 91013 denotes the performance of stimulation or perfusion during a separately reportable esophageal manometric study. Esophageal manometry assesses esophageal muscle pressure and motility, commonly used in the diagnosis and management of gastroesophageal reflux disease (GERD) and related motility disorders. Nationally, accurate coding for this service supports appropriate clinical documentation, claims submission, and aggregation of utilization for esophageal physiologic testing.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context, typical sites of service, and the service type. The publication also summarizes common billing modifiers and payer coverage considerations, outlines documentation elements needed for claim support, and highlights related service codes and reporting scenarios. This information is intended to help coding professionals, billing staff, and clinical leaders understand where CPT code 91013 fits within esophageal diagnostic services and what to expect in payer interactions and reporting.
Billing Code Overview
CPT code 91013 describes a service in which the provider performs stimulation or perfusion concurrently with a separately reportable esophageal manometric study. The procedure uses a manometer to measure and analyze esophageal muscle pressure and motility, typically performed for patients with suspected or established gastroesophageal reflux disease (GERD) or other esophageal motility disorders. The provider interprets the manometry findings and prepares a formal report.
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Service type: Diagnostic esophageal manometry with concurrent stimulation or perfusion
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Typical site of service: Hospital outpatient department or ambulatory surgical/diagnostic center; may also be performed in specialized gastroenterology clinics equipped for esophageal physiologic testing
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient with chronic heartburn, regurgitation, and poor response to proton pump inhibitor therapy is referred for esophageal manometry to evaluate esophageal motility and lower esophageal sphincter (LES) function. During the same session, the provider performs stimulation or perfusion testing using a manometer to assess pressure responses and coordinated esophageal muscle activity. The procedure is performed in an outpatient gastroenterology clinic or hospital-based GI laboratory with nursing support; topical anesthesia or sedation may be used per protocol. The provider places the manometry catheter, acquires baseline pressure tracings, administers perfusion or pharmacologic stimulation as indicated, interprets the pressure–time plots, documents LES relaxation, peristaltic integrity, and any provocative testing results, and prepares a formal report for the referring clinician. Typical documentation includes indication (for example, refractory GERD symptoms), consent, catheter placement and calibration details, timed bolus or perfusion events, interpretation of findings, and the signed report.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation/report is billed separate from technical services. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as typically described. |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to patient intolerance or adverse event. |
59 | Distinct procedural service | Use when a separate, distinct procedure is performed in the same session and needs segregation from other services. |
62 | Two surgeons | Use when two surgeons share responsibility for the procedure in complex cases. |
78 | Return to operating/procedure room for related procedure during postoperative period | Use if the patient requires a repeat invasive procedure related to the initial manometric study during the global period. |
80 | Assistant surgeon | Use when an assistant surgeon participates and billing requires an assistant modifier. |
82 | Assistant surgeon (when qualified resident unavailable) | Use when an assistant is required and no qualified resident is available. |
22 | Increased procedural services | Use when the procedure requires substantially greater effort or time than typical and documentation supports increased work. |
23 | Unusual anesthesia | Use when general or regional anesthesia is administered for reasons outside the typical scope for this procedure. |
59 | Distinct procedural service | (Note: already listed above) |
76 | Repeat procedure by same provider | Use when the exact procedure is repeated later the same day by the same provider. |
77 | Repeat procedure by another provider | Use when the exact procedure is repeated later the same day by a different provider. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Gastroenterology | Most common specialty performing esophageal manometry and perfusion/stimulation testing. |
| 207RR0500X | Internal Medicine - Gastroenterology | Hospital-based internist with GI focus performing or interpreting motility studies. |
| 2080P0004X | General Surgery | Foregut or esophageal surgeons who may perform diagnostic motility testing in surgical planning. |
| 2084P0800X | Pulmonology | Occasionally involved when aspiration risk or concurrent airway issues are assessed; less common. |
| 207L00000X | Family Medicine | May refer and sometimes perform basic motility testing in outpatient settings with appropriate training. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K21.9 | Gastro-esophageal reflux disease without esophagitis | Common indication for esophageal manometry and stimulation/perfusion to evaluate LES function and motility. |
R13.10 | Dysphagia, unspecified | Dysphagia prompts motility testing to assess peristalsis and sphincter coordination; stimulation/perfusion may be used diagnostically. |
K22.7 | Achalasia of cardia | Esophageal manometry is diagnostic for achalasia; provocative testing can clarify subtype and guide therapy. |
K22.2 | Diverticulum of esophagus | Motility testing can detect associated motility disorders that contribute to symptomatology. |
R14.0 | Abdominal distension (bloating) | When associated with esophageal symptoms, motility testing helps evaluate functional contributors. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
91010 | Esophageal motility study, multiple channel, using manometry catheter; interpretation and report | Baseline esophageal manometric study often performed in the same session; 91013 documents stimulation/perfusion performed at the same session as a separately reportable manometric study. |
43235 | Upper gastrointestinal endoscopy including esophagogastroduodenoscopy (diagnostic) | May be performed before or after manometry for mucosal evaluation when indicated in the diagnostic workup for GERD or dysphagia. |
91011 | Esophageal motility study, single channel, using manometry catheter; interpretation and report | Alternative manometry code depending on catheter configuration; 91013 applies when stimulation/perfusion is added to a separately reportable manometric study. |
31575 | Laryngoscopy, flexible; diagnostic | May be used when concurrent evaluation of the larynx/pharynx is indicated for reflux-related symptoms and aspiration concerns. |
99152 | Moderate sedation services provided by the physician or other qualified health care professional, initial 15 minutes | Applied when moderate sedation is administered for the procedure and billed separately according to payer policy. |