Summary & Overview
CPT 91035: Telemetry pH Monitoring for Gastroesophageal Reflux
CPT code 91035 represents diagnostic gastroesophageal reflux testing performed with telemetry pH electrode placement. This procedure involves placement of a pH sensor, continuous telemetry recording of esophageal acid exposure, and professional interpretation and reporting. Nationally, accurate coding and documentation for ambulatory pH monitoring are important for appropriate clinical management of gastroesophageal reflux disease (GERD), quality measurement, and claims adjudication.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and procedural components tied to 91035, common payer considerations, and guidance on where to look for coverage policy or medical necessity criteria. The publication outlines benchmarks and utilization context where available, notes typical sites of service (outpatient clinics, ambulatory surgery centers, and hospital outpatient departments), and summarizes what to expect in terms of documentation elements needed to support billing.
This summary is intended for a national audience of clinicians, coding professionals, and policy analysts seeking a concise reference on the clinical purpose and billing context of CPT code 91035.
Billing Code Overview
CPT code 91035 describes a gastroesophageal reflux test using telemetry pH electrode placement. The provider performs placement of a telemetry pH electrode, records the pH monitoring data, and interprets the recorded report to determine the presence and extent of acid reflux from the stomach into the esophagus.
Service Type: Diagnostic gastroesophageal reflux testing with telemetry pH monitoring
Typical Site of Service: Outpatient clinic, ambulatory surgery center, or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by a gastroenterologist for ambulatory wireless or catheter-based esophageal pH monitoring with telemetry electrode placement to evaluate suspected gastroesophageal reflux disease (GERD) or refractory reflux symptoms. The patient often has persistent heartburn, regurgitation, chest pain, or extraesophageal symptoms (chronic cough, laryngitis) despite empiric proton pump inhibitor therapy, or requires objective preoperative evaluation prior to anti-reflux surgery.
Workflow: The patient presents to an outpatient gastroenterology clinic or ambulatory procedure center. After history and physical exam and counseling, the provider places a pH telemetry electrode or catheter in the distal esophagus (endoscopic or transnasal placement per device instructions), documents placement and baseline calibration, and instructs the patient on recording symptoms and activity while ambulatory for a 24–48 hour monitoring period. The provider obtains the recorded pH tracing, interprets acid exposure times, symptom association indices, and compiles a formal report. The study is usually performed in an outpatient clinic, ambulatory surgery center, or endoscopy suite and billed by the interpreting provider using 91035 for telemetry pH electrode placement with recording and interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |