Billing code 91040: Balloon distension testMedicare rate & RVUs in Colorado
Reports an esophageal balloon distension study that measures luminal opening and distensibility, often during endoscopy, to evaluate suspected outflow or motility disorders.
Medicare pays $611.34 for 91040 in the office in Colorado (Colorado). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 91040 covers
During this diagnostic study, a compliant balloon catheter is positioned in the esophagus and inflated in a controlled manner while the device records changes in luminal dimensions and distension response. Impedance planimetry systems such as EndoFLIP are commonly used to characterize opening in the esophageal body or at the esophagogastric junction. Gastroenterologists typically perform the test in an endoscopy unit to evaluate suspected achalasia or other esophageal outflow disorders, or to assess physiologic response after treatment.
Report 91040 for the balloon-based distension assessment and its interpretation, not for conventional pressure-channel manometry, reflux monitoring, or the endoscopic examination itself. Documentation should identify the clinical question, balloon-based measurements and findings, and the physician’s interpretation. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. The service may be billed globally or split into professional interpretation with modifier 26 and technical equipment and staff with modifier TC. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
91040 in Colorado
| Payment locality | Office | Facility |
|---|---|---|
| Colorado | $611.34 | Unavailable |
How the 91040 rate is calculated
Each of 91040’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 91040
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.95Practice expense 16.24Malpractice 0.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 91040
The CMS indicators that decide how 91040 is paid alongside other services.
CMS payment indicators · 91040
Balloon distension test
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
91040 without 26 · national office
$576.83
Balloon distension test
91040-26 · Professional component
$51.44
Pays only the interpretation and report.
91040 compared with similar codes
Compare codes
91040 vs 91010 vs 91013 vs 91035: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 91010Esophageal manometry
- Choose 91010 for an esophageal motility study based on pressure patterns. Choose 91040 when the study measures luminal opening and distension response with a balloon.
- 91013Esophageal motility
- 91013 is esophageal motility testing with stimulation or perfusion. It does not describe the balloon-based assessment of esophageal distensibility reported with 91040.
- 91035Reflux testing
- 91035 is an electrode-based esophageal reflux test. It addresses reflux rather than the opening and distension response measured by 91040.
91040 billing questions
How does 91040 differ from esophageal manometry?
91040 evaluates how the esophageal lumen opens during balloon distension. Esophageal manometry measures pressure patterns and contractions through pressure sensors.
Does 91040 include the endoscopic examination?
No. 91040 represents the balloon distension assessment and its interpretation, not the endoscopic examination. Report an endoscopy only when it is separately performed and its documentation supports that service.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service, including equipment and staff. Without either modifier, the claim represents the global service.
Can modifier 50 be used when the test evaluates both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What documentation supports reporting 91040?
Document the clinical question, the balloon-based measurements and findings, and the physician’s interpretation. The record should make clear that the service assessed distension and luminal opening rather than only pressure patterns or reflux.
What surgical-assistance rules apply?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery billing are not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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