Summary & Overview
CPT 91124: Rectal Sensation, Tone, and Compliance Study
CPT code 91124 denotes a rectal sensation, tone, and compliance study that objectively evaluates rectal sensory thresholds, muscular tone, and compliance (stretch and relaxation), often using a barostat or balloon system. Nationally, this physiologic diagnostic test is important for diagnosing defecatory disorders, fecal incontinence, and causes of chronic constipation when structural imaging is unrevealing; it informs clinical management and suitability for specialized therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, typical sites of service, and where this test fits into the diagnostic pathway for anorectal dysfunction.
Readers will learn the clinical context for ordering a rectal compliance study, how the service is performed, benchmark considerations for utilization and site-of-service, and common coding and billing considerations. The report highlights national policy and coverage trends, typical clinical indications, and operational implications for facilities that perform anorectal physiologic testing. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 91124 describes a rectal sensation, tone, and compliance study used to evaluate rectal sensory thresholds, muscular tone, and how the rectum stretches and relaxes. The procedure typically uses specialized equipment such as a barostat or balloon system to measure pressures and volume responses within the rectum.
Service type: Physiologic diagnostic testing of anorectal function
Typical site of service: Hospital outpatient department, ambulatory surgery center, or specialized gastroenterology/urogynecology motility lab
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred to a gastroenterology or colorectal physiology lab for evaluation of chronic constipation, fecal incontinence, incomplete evacuation, or suspected dyssynergic defecation. The patient has persistent symptoms despite conservative therapy (fiber, laxatives, pelvic floor biofeedback) and may have prior anorectal manometry suggesting abnormal rectal sensation, compliance, or tone. The clinical workflow begins with history and focused anorectal exam, review of prior investigations (anorectal manometry, colonoscopy if indicated), and informed consent. On the test day, the patient is positioned in left lateral decubitus; a compliant balloon catheter or barostat device is inserted into the rectum. Graded balloon distensions are performed while the provider records thresholds for first sensation, urge, and maximum tolerated volume, along with measures of rectal compliance and tone. Results are interpreted by the performing gastroenterologist or colorectal surgeon and used to guide management such as biofeedback therapy, neuromodulation candidacy, or surgical planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician interpretation/report for a facility-performed physiologic study |
TC |