Billing code 91065: Breath testMedicare rate & RVUs in Nebraska
Measures exhaled hydrogen and/or methane after a test substrate to evaluate suspected carbohydrate malabsorption or intestinal bacterial overgrowth.
Medicare pays $59.65 for 91065 in the office in Nebraska (Nebraska). 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 8 sections
What 91065 covers
The test measures hydrogen and/or methane in a patient’s breath after administration of a test substrate. Gastroenterology practices and diagnostic laboratories commonly use it to investigate suspected lactose or fructose malabsorption and intestinal bacterial overgrowth. Serial breath measurements are interpreted in relation to the administered substrate and the clinical question; this is not an esophageal pressure or reflux study.
Report the service when the hydrogen/methane breath test is performed, with documentation identifying the indication, substrate or protocol, test results, and interpretation. The global service includes both the professional interpretation and technical work; modifier 26 identifies interpretation, while modifier TC identifies equipment and staff. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate for this test. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery 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.
91065 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $59.65 | Unavailable |
How the 91065 rate is calculated
Each of 91065’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 · 91065
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.20Practice expense 1.71Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 91065
The CMS indicators that decide how 91065 is paid alongside other services.
CMS payment indicators · 91065
Breath 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
91065 without 26 · national office
$64.46
Breath test
91065-26 · Professional component
$9.69
Pays only the interpretation and report.
91065 compared with similar codes
Compare codes
91065 vs 83013 vs 91010: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 83013H pylori (c-13) breath
- 83013 is for H. pylori breath-test analysis. Use 91065 for hydrogen and/or methane testing directed at conditions such as carbohydrate malabsorption or bacterial overgrowth.
- 91010Esophageal manometry
- 91010 evaluates esophageal motility using pressure measurements. Code 91065 measures exhaled gases after a test substrate.
91065 billing questions
When is 91065 appropriate instead of an H. pylori breath-test code?
Use 91065 for hydrogen and/or methane testing directed at issues such as carbohydrate malabsorption or bacterial overgrowth. H. pylori breath testing uses codes for that specific diagnostic target, such as 83013.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service; billing without either modifier represents the global service.
Should modifier 50 be appended for this test?
No. The CMS facts identify bilateral adjustment as inappropriate for this service.
What documentation supports reporting 91065?
Document the clinical indication, the test protocol or substrate, the breath measurements, and the interpretation. These details support that the service was a hydrogen/methane breath test rather than another gastrointestinal diagnostic study.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included in the service.
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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