$243.32
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.
On this page
CMS RVU26D · Effective 2026-10-01
91040 Balloon distension test Medicare reimbursement rates in Delaware
Reports an esophageal balloon distension study that measures luminal opening and distensibility, often during endoscopy, to evaluate suspected outflow or motility disorders. Compare 91040 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 91040 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$570.21
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Esophageal function testing
About 91040: Esophageal balloon distension study
Reports an esophageal balloon distension study that measures luminal opening and distensibility, often during endoscopy, to evaluate suspected outflow or motility disorders.
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.
CMS billing rules for 91040
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.95 · 6%
- Practice expense (office) RVU16.24 · 94%
- Malpractice RVU0.08 · 0%
5.4K
Medicare services in 2024 · #1816 by national volume
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 compared with similar codes
Office rates for Delaware, from the same CMS release.
$28.12
91013 is esophageal motility testing with stimulation or perfusion. It does not describe the balloon-based assessment of esophageal distensibility reported with 91040.
$496.76
91035 is an electrode-based esophageal reflux test. It addresses reflux rather than the opening and distension response measured by 91040.
Compare 91040 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$570.21
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 91040 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
11,615
- Code
- 91040
- Physician work
- 0.95
- Practice expense
- 16.24
- Malpractice
- 0.08
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.95 | × 1.005 | 0.9547 |
| Practice expense | 16.24 | × 0.988 | 16.0451 |
| Malpractice | 0.08 | × 0.899 | 0.0719 |
| Total RVUs | 17.0718 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$570.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.95 | 1.005 |
| Practice expense | 16.24 | 0.988 |
| Malpractice | 0.08 | 0.899 |
(0.95 × 1.005 + 16.24 × 0.988 + 0.08 × 0.899) × $33.4009 = $570.21
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,61291038,,Esoph imped funct test > 1hr,A,,1.10,12.17,,12.17,NA,0.08,13.35,13.35,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,61391038,26,Esoph imped funct test > 1hr,A,,1.10,0.63,,0.63,,0.06,1.79,1.79,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,61491038,TC,Esoph imped funct test > 1hr,A,,0.00,11.54,,11.54,NA,0.02,11.56,11.56,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,61591040,,Esoph balloon distension tst,A,,0.95,16.24,,16.24,NA,0.08,17.27,17.27,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,61691040,26,Esoph balloon distension tst,A,,0.95,0.52,,0.52,,0.07,1.54,1.54,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,61791040,TC,Esoph balloon distension tst,A,,0.00,15.72,,15.72,NA,0.01,15.73,15.73,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,61891065,,Breath hydrogen/methane test,A,,0.20,1.71,,1.71,NA,0.02,1.93,1.93,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503