Summary & Overview
CPT 91125: Anorectal Manometry and Rectal Function Testing
CPT code 91125 represents anorectal manometry, a diagnostic physiologic test that assesses anal sphincter and rectal muscle pressures and coordination, often combined with rectal sensation testing and a balloon expulsion test. This test is clinically important for evaluating patients with chronic constipation, fecal incontinence, evacuation disorders, and other anorectal dysfunctions. Nationally, accurate coding for 91125 supports appropriate clinical management pathways and claims processing for specialty gastroenterology and motility services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, service and site-of-care considerations, and commonly referenced related services. The publication highlights benchmarks and reimbursement context where available, typical clinical indications tied to the procedure, and policy elements that influence coverage and documentation expectations. Practical details address operational settings such as outpatient gastroenterology clinics and motility laboratories, helping clinical administrators and billing staff align coding with service delivery. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 91125 describes anorectal manometry testing, a physiological assessment that measures anal sphincter and rectal muscle pressures during rest, voluntary squeeze, and simulated defecation. The procedure may include rectal sensation testing and a balloon expulsion test as part of a combined evaluation of anorectal function.
Service type: Diagnostic physiologic testing of anorectal function
Typical site of service: Outpatient gastroenterology clinic, motility laboratory, or ambulatory surgical/diagnostic center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by a gastroenterologist for evaluation of chronic constipation and suspected pelvic floor dysfunction. The patient reports straining, sense of incomplete evacuation, and intermittent fecal incontinence. Prior evaluation included history and physical, anorectal exam, and colonoscopy or flexible sigmocopy as indicated. The clinical workflow includes: pre-procedure assessment for contraindications (recent rectal surgery, active proctitis), informed consent, bowel regimen instructions, and positioning in the motility laboratory. The provider applies a pressure-sensing catheter into the rectum and anal canal, records resting and squeeze pressures, asks the patient to perform simulated defecation maneuvers, performs rectal sensory testing with graded balloon distension, and may perform a balloon expulsion test to assess evacuation. Data are reviewed immediately to document anal sphincter tone, rectoanal inhibitory reflex, rectal sensation thresholds, and coordination during attempted defecation. Results guide management such as biofeedback referral, pelvic floor physical therapy, or further anorectal interventions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting interpretation by the physician separate from facility technical component (rare for 91125). |