$716.65
91124 is a rectal sensation, tone, and compliance study. 91125 is the combined anorectal manometry assessment with sensory testing and balloon expulsion.
On this page
CMS RVU26D · Effective 2026-10-01
91125 Anorectal testing Medicare reimbursement rates in Indiana
Reports anorectal pressure testing combined with rectal sensory assessment and balloon expulsion, commonly used to evaluate constipation, defecatory difficulty, or fecal incontinence. Compare 91125 office and facility rates across CMS payment localities in Indiana.
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 91125 in Indiana?
Indiana 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
$326.09
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Gastrointestinal testing
About 91125: Anorectal motility and expulsion assessment
Reports anorectal pressure testing combined with rectal sensory assessment and balloon expulsion, commonly used to evaluate constipation, defecatory difficulty, or fecal incontinence.
This study assesses anorectal function using a pressure-sensing catheter and rectal balloon testing. It evaluates anal sphincter pressures and coordination along with rectal sensory responses and the ability to expel a balloon. Gastroenterologists, colorectal specialists, and motility teams commonly perform it in an outpatient motility laboratory for patients with persistent constipation, suspected outlet dysfunction, or fecal incontinence.
Report 91125 when the service includes the combined anorectal manometry, sensory assessment, and balloon expulsion evaluation; document the test elements performed and relevant findings. The global service includes the professional interpretation and the technical work, equipment, and staff. When those portions are billed separately, modifier 26 identifies the interpretation and modifier TC identifies the technical service.
CMS billing rules for 91125
- 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.
Where the value comes from
- Work RVU2.70 · 26%
- Practice expense (office) RVU7.53 · 72%
- Malpractice RVU0.17 · 2%
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.
91125 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
91117 evaluates colonic motility over a study period; 91125 assesses anorectal function and evacuation.
Compare 91125 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
Indiana →
Office / nonfacility
$326.09
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 91125 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
11,637
- Code
- 91125
- Physician work
- 2.70
- Practice expense
- 7.53
- Malpractice
- 0.17
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.70 | × 1.000 | 2.7000 |
| Practice expense | 7.53 | × 0.927 | 6.9803 |
| Malpractice | 0.17 | × 0.486 | 0.0826 |
| Total RVUs | 9.7629 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$326.09
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.7 | 1 |
| Practice expense | 7.53 | 0.927 |
| Malpractice | 0.17 | 0.486 |
(2.7 × 1 + 7.53 × 0.927 + 0.17 × 0.486) × $33.4009 = $326.09
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.
91125 billing questions
When should 91125 be selected instead of 91122?
Use 91125 for the combined anorectal pressure, sensory, and balloon expulsion assessment. Use 91122 when the documented service is anorectal manometry without that combined testing.
Are sensory testing and balloon expulsion included?
They are part of the combined service represented by 91125. Document the elements performed and avoid reporting those elements again as separate services from the same test.
How are the professional and technical portions reported?
Report the global service without a component modifier. Use modifier 26 for the professional interpretation or modifier TC for the technical work, equipment, and staff when the portions are billed separately.
What documentation supports 91125?
Record the reason for testing, the anorectal measurements and sensory assessment performed, balloon expulsion results, and the interpreting clinician's findings.
Is 91125 appropriate for constipation alone?
The symptom alone does not establish the service. The record should show that the combined anorectal manometry, sensory assessment, and balloon expulsion evaluation was performed.
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.
11,63491124,,Rct snsatn tone&cmplianc std,A,,3.05,19.74,,19.74,NA,0.22,23.01,23.01,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,63591124,26,Rct snsatn tone&cmplianc std,A,,3.05,1.67,,1.67,,0.18,4.90,4.90,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,63691124,TC,Rct snsatn tone&cmplianc std,A,,0.00,18.07,,18.07,NA,0.04,18.11,18.11,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,63791125,,Anrct mano rct snsatn&balo,A,,2.70,7.53,,7.53,NA,0.17,10.40,10.40,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,63891125,26,Anrct mano rct snsatn&balo,A,,2.70,1.41,,1.41,,0.15,4.26,4.26,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,63991125,TC,Anrct mano rct snsatn&balo,A,,0.00,6.12,,6.12,NA,0.02,6.14,6.14,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,64091132,,Electrogastrography,A,,0.51,14.00,,14.00,NA,0.03,14.54,14.54,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915