Billing code 91125: Anorectal testingMedicare rate & RVUs in Utah
Reports anorectal pressure testing combined with rectal sensory assessment and balloon expulsion, commonly used to evaluate constipation, defecatory difficulty, or fecal incontinence.
Medicare pays $331.70 for 91125 in the office in Utah (Utah). 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 91125 covers
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.
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 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $331.70 | Unavailable |
How the 91125 rate is calculated
Each of 91125’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 · 91125
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.70Practice expense 7.53Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 91125
The CMS indicators that decide how 91125 is paid alongside other services.
CMS payment indicators · 91125
Anorectal testing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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
91125 without 26 · national office
$347.37
Anorectal testing
91125-26 · Professional component
$142.29
Pays only the interpretation and report.
91125 compared with similar codes
Compare codes
91125 vs 91124 vs 91117: national Medicare rates
Swap in your local Medicare rate.
How to choose
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 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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